title: Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle?
abstract: OBJECTIVE
  We determined the frequency of positive surgical margins (PSMs) in patients with extraprostatic extension (EPE) in the region of the neurovascular bundle (NVB) who underwent open radical retropubic prostatectomy by 2 experienced surgeons.
  
  
  METHODS
  A total of 204 men with EPE in the region of the NVB underwent surgery by 2 experienced surgeons. The frequency of PSMs in the area of the NVB as well as the nerve sparing status of each lobe of the prostate were determined through a retrospective investigation of the pathology database as well as the physician's database. The recovery of sexual function was determined and compared to controls.
  
  
  RESULTS
  The age, clinical stage, biopsy Gleason sum and serum prostate specific antigen of the patients operated on by surgeons 1 and 2 were similar. Surgeon 1 widely excised at least 1 neurovascular bundle in 16% of the patients and surgeon 2 in 63%. The overall frequency of PSMs at the NVB was 5.9% for surgeon 1 and 5.8% for surgeon 2. Of the evaluable patients followed for 12 months or longer 83.5% of those operated on by surgeon 1 were potent compared to 63.8% of those operated on by surgeon 2.
  
  
  CONCLUSIONS
  Visual and tactile assessment during open surgery by an experienced surgeon provides valuable information on when and where it is safe to preserve the neurovascular bundle in patients with EPE in the region of the NVB. Surgical approaches in which tactile sensation is muted or absent, laparoscopic and robotic, need to undergo a similar evaluation to determine whether magnification of the operative field is sufficient to overcome the lack of haptic feedback and ability to palpate the tissue.
authors.affiliation: James Buchanan Brady Urological Institute and The Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hernandez
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Toyonori
authors.initials: T
authors.lastname: Tsuzuki
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011467:Prostate / Q000098:blood supply / Q000294:innervation; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies