Use of a Flexible Carbon Dioxide Laser Fiber for Precise Dissection of the Neurovascular Bundle During Robot-Assisted Laparoscopic Prostatectomy

Cheetham, Philippa J.; Truesdale, Matthew D.; Lee, Dong Hoon; Landman, Jaime; Badani, Ketan K.

doi:10.1089/end.2010.0132

Cited by 14 publications

(4 citation statements)

References 20 publications

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“…Others have shown that coagulation of arterial and venous blood vessels with lumens in the range of 1 mm or larger is more efficient using a bipolar cautery than using lasers [ 23 , 24 ]. However, the CO 2 laser is well suited as both a dissecting and coagulating tool when nerve function is taken into consideration because it can be operated contact-free in small and poorly accessible sites [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Functional and Physical Outcomes following Use of a Flexible CO₂Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Robinson

Fishman

Bendok

et al. 2015

BioMed Research International

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This study compared functional and physical collateral damage to a nerve when operating a Codman MALIS Bipolar Electrosurgical System CMC-III or a CO2 laser coupled to a laser, with correlation to an in vitro model of heating profiles created by the devices in thermochromic ink agarose. Functional damage of the rat sciatic nerve after operating the MALIS or CO2 laser at various power settings and proximities to the nerve was measured by electrically evoked nerve action potentials, and histology of the nerve was used to assess physical damage. Thermochromic ink dissolved in agarose was used to model the spatial and temporal profile of the collateral heating zone of the electrosurgical system and the laser ablation cone. We found that this laser can be operated at 2 W directly above the nerve with minimal damage, while power settings of 5 W and 10 W resulted in acute functional and physical nerve damage, correlating with the maximal heating cone in the thermochromic ink model. MALIS settings up to 40 (11 W) did not result in major functional or physical nerve damage until the nerve was between the forceps tips, correlating with the hottest zone, localized discretely between the tips.

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Section: Discussionmentioning

confidence: 99%

Functional and Physical Outcomes following Use of a Flexible CO₂Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Robinson

Fishman

Bendok

et al. 2015

BioMed Research International

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“…The study showed that using these lasers is a safe and easy technique for dissection of the NVB during nerve-sparing RARP. It also was successful in showing that 70% of the patients regained urinary continence by 6 weeks after the surgery, and 90% regained continence at 3 months after surgery [45] .…”

Section: Recent Advancesmentioning

confidence: 93%

“…In a pilot study, Cheetham et al [45] evaluated the delivery mechanism of a CO 2 laser energy through a fibre to enhance the accuracy of dissection of the NVB during RARP. They used a CO 2 laser fibre that transmits energy with minimal absorptive loss.…”

Section: Recent Advancesmentioning

confidence: 99%

Robotic radical prostatectomy: The new gold standard

Chopra

Srivastava

Tewari

2012

Arab Journal of Urology

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ObjectivesOpen radical prostatectomy (RP) has been the standard and primary treatment for focal prostate cancer. However, in recent years this view has changed, as robot-assisted laparoscopic RP has gained acceptance among urologists. In this review we evaluate the importance and place of robotics in laparoscopic urological surgery, discussing several techniques that are currently being used and potentially new techniques that might be used in the future.MethodsWe systematically reviewed papers published between 1998 and 2011 using the keywords ‘robotic prostatectomy’ ‘gold standard’ and the Medline database. In addition, after selecting relevant reports we searched ‘related citations’ of the documents to find further supporting published papers.ResultsIn all, 50 original papers were identified using the search criteria; we also found 28 through ‘related citations’ browsing. Papers were selected according to their relevance to the current topic (i.e. RP, original articles) and incorporated into this review. These papers were used for their information on the advantages of using robotics, as well as innovative ideas being used in the field of robotic urological surgery.ConclusionAlmost a decade after the first robotic RP many reports show the benefits and advantages of incorporating robotics into urological surgery. Robotic surgery decreases the learning curve necessary for surgeons when compared with laparoscopic techniques. In addition, patients prefer robotics, as the procedure is less invasive, diminishes the duration of hospitalisation and speeds the return to function.

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“…The authors reported that the laser system enabled a meticulous dissection of the NVBs and easy fascial layer identification. According to them, 90% of patients who underwent this approach had gained urinary continence at 3 months after surgery with no data concerning potency reported [ 58 ]. The 532 nm KTP laser is characterised by both good hemostatic properties and a shallow depth of penetration.…”

Section: The Role Of Lasers In Nsmentioning

confidence: 99%

Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes

Kyriazis

Spinos

Tsaturyan

et al. 2022

Cancers

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The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.

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Use of a Flexible Carbon Dioxide Laser Fiber for Precise Dissection of the Neurovascular Bundle During Robot-Assisted Laparoscopic Prostatectomy

Cited by 14 publications

References 20 publications

Functional and Physical Outcomes following Use of a Flexible CO₂Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Functional and Physical Outcomes following Use of a Flexible CO₂Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Robotic radical prostatectomy: The new gold standard

Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes

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Use of a Flexible Carbon Dioxide Laser Fiber for Precise Dissection of the Neurovascular Bundle During Robot-Assisted Laparoscopic Prostatectomy

Cited by 14 publications

References 20 publications

Functional and Physical Outcomes following Use of a Flexible CO2Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Functional and Physical Outcomes following Use of a Flexible CO2Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Robotic radical prostatectomy: The new gold standard

Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes

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Product

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Functional and Physical Outcomes following Use of a Flexible CO₂Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model

Functional and Physical Outcomes following Use of a Flexible CO₂Laser Fiber and Bipolar Electrocautery in Close Proximity to the Rat Sciatic Nerve with Correlation to an In Vitro Thermal Profile Model