Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes

Abstract

Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). The clipless intrafascial neurovascular bundle-sparing technique aims to preserve periprostatic structures and neurovascular bundles as much as possible by avoiding clipping of the vascular pedicles. This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundle-sparing RARP. Intact erectile function was defined as score ≥ 21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse. Median follow-up was 26.5 months (IQR 15.25–48). Postoperative erectile function recovery rates were 71.4%, 81.9%, 88.6%, 92.4%, and 94.3% at 1, 3, 6, 9, and 12 months, respectively. The rate of positive surgical margins was 16.2% overall and 11.8% in patients with stage pT2 disease. The biochemical recurrence rate was 6.7% overall. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Further large-scale prospective comparative studies are warranted.

Long-Term Oncological Outcomes After Nerve-Sparing Robot-Assisted Radical Prostatectomy for High-Risk Localised Prostate Cancer: A Single-Center, Two-Arm, Prospective Study

“…This cohort included only 8.2% of patients with high-risk prostate cancer. Another smaller, more recently conducted study [12] enrolled 105 prostate cancer patients who underwent intrafascial NS-RARP and were followed-up for 26.5 months (IQR 15.25-48). Importantly, 6-and 12-month postoperative erectile function recovery rates were 88.6% and 94.3%, with an overall positive surgical margins rate of 16.2% and an overall BCR rate of 6.7%.…”

Monitoring the delicate operations of surgical robots via ultra-sensitive ionic electronic skin

“…Medical equipment is critical for healthcare and health promotion [ 1 , 2 ]. As a landmark of high-end medical equipment and important cutting-edge research fields today, surgical robots are having a revolutionary impact on disease diagnosis [ 3 ], surgery [ 4–8 ], rehabilitation [ 7 , 8 ] and medical services [ 9 ], and are leading the development of precision medicine, telemedicine and smart medicine [ 3–9 ]. Compared with traditional manual surgery, robot-assisted surgery has higher operation precision and better operation quality; this has been demonstrated in neurosurgery [ 4 , 10 ], cardiothoracic surgery [ 11 ], gynecology [ 12 , 13 ], urology [ 5 , 8 ] and other fields [ 1 , 3 , 6 , 7 , 14 ].…”

“…As a landmark of high-end medical equipment and important cutting-edge research fields today, surgical robots are having a revolutionary impact on disease diagnosis [ 3 ], surgery [ 4–8 ], rehabilitation [ 7 , 8 ] and medical services [ 9 ], and are leading the development of precision medicine, telemedicine and smart medicine [ 3–9 ]. Compared with traditional manual surgery, robot-assisted surgery has higher operation precision and better operation quality; this has been demonstrated in neurosurgery [ 4 , 10 ], cardiothoracic surgery [ 11 ], gynecology [ 12 , 13 ], urology [ 5 , 8 ] and other fields [ 1 , 3 , 6 , 7 , 14 ]. It has been pointed out in surgical research reports that the robot-assisted method can improve medical surgeries through a remote control system [ 1 , 3 , 4 ], thus increasing surgical efficiency, reducing operation complications and relieving surgeons’ fatigue [ 12 ].…”

Nerve-sparing Techniques During Robot-assisted Radical Prostatectomy: Clips or Low-energy Bipolar Coagulation? Low Energy

“…In the literature and in our daily practice, there is still a debate regarding the use of low-energy coagulation versus clips: some experts reported the same success rates in terms of continence and sexuality for low-energy bipolar coagulation and athermal dissection [3] , [4] , [5] , [6] . The objective is to review these reports in favor of a clipless approach.…”

“…Shin and Lee [5] reported 1-yr functional and oncologic outcomes and postoperative complications for 105 patients who underwent modified clipless RARP with intrafascial NVB sparing. Over median follow-up of 26.5 mo, the rate of postoperative erectile function recovery, defined as a score ≥21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse, was 71%, 81%, 88%, 92%, and 94% at 1, 3, 6, 9, and 12 mo, respectively.…”