title: Athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy.
abstract: While cancer control is the primary objective of radical prostatectomy, maintenance of sexual function is a priority for the majority of men presenting with prostate cancer. Preservation of the neurovascular bundles is the challenging and critical step of radical prostatectomy with regards to maintenance of potency. The objective of this study is to describe the surgical steps of our hybrid technique: athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy. This technique involves releasing the neurovascular bundle in a retrograde direction from the apex toward the base of the prostate, during an antegrade prostatectomy. It is a hybrid of the traditional open and the laparoscopic approaches to nerve sparing. With this approach we are able to clearly delineate the path of the bundle and avoid inadvertently injuring it when controlling the prostatic pedicle. Our hybrid nerve-sparing technique combines aspects of the traditional open anatomical approach with those of the laparoscopic antegrade approach. The benefits of robotic technology allow a retrograde neurovascular bundle dissection to be performed during an antegrade radical prostatectomy.
authors.affiliation: Department of Urology, Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida, Orlando, FL, USA. geoffrey.coughlin@flhosp.org.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Coughlin
authors.affiliation: The James Cancer Center, Ohio State University, Columbus, OH, USA.
authors.forename: Pankaj P
authors.initials: PP
authors.lastname: Dangle
authors.affiliation: Department of Urology, Global Robotics Institute Latin America, Florida Hospital Celebration Health, University of Central Florida, Orlando, FL, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Palmer
authors.affiliation: Global Robotics Institute, Florida Hospital Celebration Health, Orlando, FL, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Samevedi
authors.affiliation: Department of Urology, Global Robotics Institute and Urologic Oncology Program, Florida Hospital Celebration Health, University of Central Florida, Orlando, FL, USA.
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
keywords: Functional outcomes; Nerve sparing; Robotic prostatectomy; Robotic-assisted laparoscopic prostatectomy (RALP)