Laser robotically assisted nerve-sparing radical prostatectomy: a pilot study of technical feasibility in the canine model.
OBJECTIVE
To examine the feasibility of using laser energy during nerve-sparing robotically assisted radical prostatectomy (RARP), as the energy sources currently used for haemostasis in RARP adversely affect cavernous nerve function, while clips require application by a skilled assistant, but laser energy potentially allows precise dissection with minimal collateral tissue injury.


METHODS
We used laser-based RARP in 10 dogs, using the da Vinci S system (Intuitive Surgical, Sunnyvale, CA, USA) and a prototype robotic laser instrument. The potassium-titanyl-phosphate laser was used for dissection at 2-6 W, with intermittent use of the neodymium-doped yttrium-aluminium-garnet laser at 5 W for coagulating larger vessels. The peak intracavernosal pressure response to nerve stimulation was recorded as a percentage of mean arterial pressure (ICP%MAP) before and after RARP. Five dogs were killed immediately after RARP and five were maintained alive for 72 h; the haemoglobin and haematocrit levels were measured before and after RARP in the latter five dogs.


RESULTS
All 10 procedures were performed solely using laser energy and no additional haemostatic manoeuvres. The median prostate excision time was 65 min. The ICP%MAP before and after RARP (median 98.5% and 77.0%, P = 0.12) were not significantly different; similarly, the respective haemoglobin (median 14.4 vs 12.6 g/dL, P = 0.06) and haematocrit levels (45.1% vs 40.2%, P = 0.06) were not significantly different. Two dogs had catheter-related complications and one had an anastomotic leak. There were no laser-related complications or postoperative haemorrhage.


CONCLUSIONS
Laser RARP is feasible in dogs and further assessment is warranted.
Gianduzzo
Troy
T
Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Colombo
Jose R
JR
Haber
Georges-Pascal
GP
Hafron
Jason
J
Magi-Galluzzi
Cristina
C
Aron
Monish
M
Gill
Inderbir S
IS
Kaouk
Jihad H
JH
D000818:Animals; D004285:Dogs; D005240:Feasibility Studies; D010535:Laparoscopy; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D010413:Penis / Q000294:innervation*; D010865:Pilot Projects; D011467:Prostate / Q000294:innervation* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics