Robot-assisted vessel harvesting for penile revascularization.
BACKGROUND
Ideal candidates for penile revascularization include young patients with documented vasculogenic erectile dysfunction usually resulting from pelvic trauma. Historically, large midline incisions were necessary to harvest the epigastric vessels for penile revascularization. We report our experience with robot-assisted epigastric vessel harvesting for use in penile revascularization procedures.


OBJECTIVE
To describe our technique and experience with robot-assisted vessel harvesting for use in penile revascularization.


METHODS
Five patients were selected for penile revascularization. Each patient suffered pelvic crush injuries resulting in post-traumatic erectile dysfunction. Each patient had no significant prior medical history and had normal erectile function prior to injury. Penile duplex Doppler ultrasound studies using vasoactive agents demonstrated decreased arterial inflow. Complementary pelvic angiography documented the corresponding arterial lesions. Each patient underwent attempted penile revascularization using a modified Virag-V technique. The epigastric artery was harvested robotically and transposed through a 3 cm incision at the base of the penis. Microscopic revascularization was performed by anastamosing the epigastric artery to the deep dorsal vein. Distal dorsal vein ligation of the subcoronal plexus was performed to limit glans hyperemia.


METHODS
Description of a new method of vessel harvesting for penile revascularization.


RESULTS
Penile revascularization was successful in four out of five patients. One patient had complete thrombosis of the deep dorsal penile vein and underwent subsequent penile prosthesis implantation. Each patient undergoing successful revascularization was discharged home two days postoperatively and has reported resumption of sexual activity.


CONCLUSIONS
The robot-assisted approach to epigastric vessel harvesting is an ideal minimally-invasive complement to penile revascularization. This procedure negates the need for a large midline incision and may shorten recovery time. Our described technique offers a novel option for the application of minimally-invasive technology, but longer-term follow-up is needed to further evaluate the success of penile revascularization.
Raynor
Mathew C
MC
Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana, USA.
Davis
Rodney
R
Hellstrom
Wayne J G
WJ
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D019074:Epigastric Arteries / Q000637:transplantation*; D006801:Humans; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010388:Pelvis / Q000293:injuries; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult