Sural nerve graft during laparoscopic radical prostatectomy. Initial experience.
OBJECTIVE
To determine the technical feasibility of sural nerve grafting for restoration of cavernous nerve continuity after radical retropubic prostatectomy by the laparoscopic approach.


METHODS
15 potent men (mean age: 56+/-4 years) underwent laparoscopic radical prostatectomy with deliberate wide uni- or bilateral neurovascular bundle resection. After prostatectomy, but before the vesicourethral anastomosis, an autologous sural nerve graft was interposed between the divided end of the cavernous nerves using a laparoscopic approach.


RESULTS
All 15 procedures could be completed laparoscopically. Visual cooptation between the nerve graft and the cut ends of the neurovascular bundles was possible in all 15 cases. Surgical time for the entire procedure ranged between 210 to 275 min with 30 to 60 min of this time required for the nerve harvest and graft.


CONCLUSIONS
This experience demonstrates that sural nerve graft replacement is technically feasible by the laparoscopic approach. The magnified optics, bloodless surgical field, and improved instrumentation create an optimal environment for sural nerve grafting to the cut ends of the neurovascular bundles. Quality of life survey data at 12 to 18 month follow-up will be needed to assess functional return.
Turk
Ingolf Arthur
IA
Department of Urology, Eastern Virginia Medical School, 600 Gresham Drive, RP 203, Norfolk, VA 23507, USA. harrytuerk@aol.com
Deger
Serdar
S
Morgan
William Ritchie
WR
Davis
John Warren
JW
Schellhammer
Paul F
PF
Loening
Stefan A
SA
D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D013497:Sural Nerve / Q000637:transplantation*