Techniques of nerve-sparing and potency outcomes following robot-assisted laparoscopic prostatectomy.
OBJECTIVE
Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP).


METHODS
We performed a MEDLINE search from 2001 to 2009 using the keywords "robotic prostatectomy", "cavernosal nerve", "pelvic neuroanatomy", "potency", "outcomes" and "comparison". Extended search was also performed using the references from these articles.


RESULTS
Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, "the veil of Aphrodite", "athermal retrograde neurovascular release", "clipless antegrade nerve sparing" and "clipless cautery free technique". The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript.


CONCLUSIONS
The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.
Chauhan
Sanket
S
Global Robotics Institute, Florida Hospital - Celebration Health, Department of Urology, University of Central Florida School of Medicine, Celebration, Florida, USA.
Coelho
Rafael F
RF
Rocco
Bernardo
B
Palmer
Kenneth J
KJ
Orvieto
Marcelo A
MA
Patel
Vipul R
VR
D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000294:innervation; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome