title: Tension and energy-free robotic-assisted laparoscopic radical prostatectomy with interfascial dissection of the neurovascular bundles.
abstract: OBJECTIVE
  To assess overall safety, histopathological outcomes, and early functional results after robotic-assisted laparoscopic radical prostatectomy (RALP) with a new lateral approach for the interfascial dissection of the neurovascular bundles without tension and any use of electrocautery.
  
  
  METHODS
  Between April and September 2006, 100 consecutive patients with organ-confined prostate cancer (age < 70 yr, PSA < or = 10 microg/dl, Gleason score < or = 7, and IIEF > or = 17) underwent RALP by the same senior surgeon. Pre-, intra-, and perioperative data were recorded. The operative technique is described step by step. Patients were assessed at the 4-mo follow-up.
  
  
  RESULTS
  RALP was successfully completed in all patients. Neither blood transfusions nor reintervention were necessary. One week following catheter removal, complete early urinary continence was achieved in 80% of patients, and spontaneous erections or penile tumescence was reported by 46 patients. Positive surgical margins were 12.1% in the pT2 group and 29% in the pT3 group. Ninety-three patients were available for analysis at the 4-mo follow-up. Of them, 92.4% were completely continent, 5.4% used 1 pad a day, and 2.2% used 2 or more pads a day. Concerning the IIEF-EF domain score, 64.5% of the patients reported a total score > or = 17, and 17.2% of them scored > or = 26.
  
  
  CONCLUSIONS
  The novel approach described for RALP is safe and allows excellent dissection. It maintains good margin status and provides encouraging early continence and erectile functional results in selected patients. Long-term follow-up is necessary to assess the impact of this approach on oncological outcome.
authors.affiliation: Service d'Urologie, Clinique Saint Augustin, Bordeaux, France. agomat@gmx.ch
authors.forename: Agostino
authors.initials: A
authors.lastname: Mattei
authors.forename: Richard
authors.initials: R
authors.lastname: Naspro
authors.forename: Filippo
authors.initials: F
authors.lastname: Annino
authors.forename: Daniel
authors.initials: D
authors.lastname: Burke
authors.forename: Romolo
authors.initials: R
authors.lastname: Guida
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
mesh_terms: D000368:Aged; D004210:Dissection / Q000379:methods*; D000071938:Fasciotomy; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000098:blood supply / Q000294:innervation / Q000601:surgery*