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01-09-2016 | Review Article

Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy

Authors: Anup Kumar, Sarvesh Tandon, Srinivas Samavedi, Vladimir Mouraviev, Anthony S. Bates, Vipul R. Patel

Published in: Journal of Robotic Surgery | Issue 3/2016

Abstract

Nerve-sparing procedures during robot-assisted radical prostatectomy (RARP) have demonstrated improved postoperative functional outcomes. This article provides an overview of clinically applied prostatic neuro-anatomy, various techniques of nerve sparing (NS), and recent innovations in NS and potency outcomes of NS RARP. We retrieved and reviewed all listed publications within PubMed using keywords: nerve sparing, robotic radical prostatectomy, prostate cancer, outcomes, pelvic neuroanatomy and potency. Studies reporting potency outcomes of NS RARP (comparative and non-comparative) were analysed using the Delphi method with an expert panel of urological robotic surgeons. Herein, we outline the published techniques of NS during RARP. Potency and continence outcomes of individual series are discussed in light of the evidence provided by case series and published trials. The potency outcomes of various comparative and non-comparative series of NS RARP have also been mentioned. There are numerous NS techniques reported for RARP. Each method is complimented with benefits and constrained by idiosyncratic caveats, and thus, careful patient selection, a wise intraoperative clinical judgment and tailored approach for each patient is required, when decision for nerve sparing is made. Further large prospective multi-institutional randomized controlled trials are required to evaluate potency and continence outcomes of these techniques, using a rigid standard patient selection criteria and definition of potency are warranted in the new era of functional outcome-driven research.

Minino AM, Smith BL (2001) Deaths: preliminary data for 2000. Natl Vital Stat Rep 49:1–40

Crawford ED (2003) Epidemiology of prostate cancer. Urology 62:3–12CrossRefPubMed

Jani AB, Johnstone PA, Liauw SL, Master VA, Brawley OW (2008) Age and grade trends in prostate cancer (1974–2003): a surveillance, epidemiology, and end results registry analysis. Am J Clin Oncol 31:375–378CrossRefPubMed

Edwards BK, Noone AM, Mariotto AB et al (2014) Annual report to the nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 120(9):1290–1314CrossRefPubMed

Ficarra V, Cavalleri S, Novara G, Aragona M, Artibani W (2007) Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol 51:45–56CrossRefPubMed

Ficarra V, Borghesi M, Suardi N et al (2013) Long-term evaluation of survival, continence and potency (SCP) outcomes after robot-assisted radical prostatectomy (RARP). BJU Int 112(3):338–345CrossRefPubMed

Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55:1037–1063CrossRefPubMed

Coelho RF, Rocco B, Patel MB (2010) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol 24(12):2003–2015CrossRefPubMedPubMedCentral

Park B, Kim W, Jeong BC et al (2013) Comparison of oncological and functional outcomes of pure versus robotic-assisted laparoscopic radical prostatectomy performed by a single surgeon Scand. J Urol 47(1):10–18

10.

Willis DL, Gonzalgo ML, Brotzman M et al (2012) Comparison of outcomes between pure laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes. BJU Int 109(6):898–905CrossRefPubMed

11.

Asimakopoulos AD, Miano R, Di Lorenzo N et al (2013) Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy comparison of pentafecta rates for a single surgeon. Surg Endosc 27(11):4297–4304CrossRefPubMed

12.

Berge V, Berg RE, Hoff JR et al (2013) A prospective study of transition from laparoscopic to robot-assisted radical prostatectomy: quality of life outcomes after 36-month follow-up. Urology 81(4):781–786CrossRefPubMed

13.

Porpiglia F, Morra I, Lucci Chiarissi M et al (2013) Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol 63(4):606–614CrossRefPubMed

14.

Asimakopoulos AD, Pereira Fraga CT, Annino F et al (2011) Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. J Sex Med 8(5):1503–1512CrossRefPubMed

15.

Ficarra V, Novara G, Ahlering TE et al (2012) Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 62(3):418–430CrossRefPubMed

16.

Ko YH, Coelho RF, Sivaraman A et al (2013) Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: which is better for achieving early functional recovery? Eur Urol 63(1):169–177CrossRefPubMed

17.

Alemozaffar M, Duclos A, Hevelone ND et al (2012) Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function. Eur Urol 61(6):1222–1228CrossRefPubMed

18.

Ficarra V, Sooriakumaran P, Novara G et al (2012) Systematic review of methods for reporting combined outcomes after radical prostatectomy and proposal of a novel system: the survival, continence, and potency (SCP) classification. Eur Urol 61(3):541–548CrossRefPubMed

19.

Kowalczyk KJ, Huang AC, Hevelone ND et al (2011) Stepwise approach for nerve sparing without countertraction during robot-assisted radical prostatectomy: technique and outcomes. Eur Urol 60(3):536–547CrossRefPubMed

20.

Patel VR, Sivaraman A, Coelho RF et al (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59(5):702–707CrossRefPubMed

21.

Patel VR, Coelho RF, Chauhan S et al (2010) Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon. BJU Int 106(5):696–702CrossRefPubMed

22.

Potdevin L, Ercolani M, Jeong J et al (2009) Functional and oncologic outcomes comparing interfascial and intrafascial nerve sparing in robot-assisted laparoscopic radical prostatectomies. J Endourol 23(9):1479–1484CrossRefPubMed

23.

Shikanov S, Woo J, Al-Ahmadie H et al (2009) Extrafascial versus interfascial nerve-sparing technique for robotic-assisted laparoscopic prostatectomy: comparison of functional outcomes and positive surgical margins characteristics. Urology 74(3):611–616CrossRefPubMed

24.

Orvieto MA, Coelho RF, Chauhan S et al (2010) Erectile dysfunction after robot-assisted radical prostatectomy. Expert Rev Anticancer Ther 10(5):747–754CrossRefPubMed

25.

Finley DS, Osann K, Skarecky D, Ahlering TE (2009) Hypothermic nerve-sparing radical prostatectomy: rationale, feasibility, and effect on early continence. Urology 73(4):691–696CrossRefPubMed

26.

Seddon HJ (1948) A review of work on peripheral nerve injuries in Great Britain during World War II. J Nerv Ment Dis 108:160–168PubMed

27.

Takenaka A, Leung RA, Fujisawa M, Tewari AK (2006) Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy. World J Urol 24(2):136–143CrossRefPubMed

28.

Srivastava A, Chopra S, Pham A (2013) Effect of a risk-stratified grade of nerve-sparing technique on early return of continence after robot-assisted laparoscopic radical prostatectomy. Eur Urol 63(3):438–444CrossRefPubMed

29.

Ludovico GM, Dachille G, Pagliarulo G et al (2013) Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients. Oncol Rep 29(6):2445–2450PubMed

30.

Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128:492–497PubMed

31.

Eckhard C (1863) Untersuchungen uber die Erection des beim Hunde. Anat Physiol 3:123–166

32.

Lepor H, Gregerman M, Crosby R, Mostofi FK, Walsh PC (1985) Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa : a detailed anatomical study of the adult male pelvis. J Urol 133(2):207–212PubMed

33.

Quinlan DM, Epstein JI, Carter BS, Walsh PC (1991) Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 145(5):998–1002PubMed

34.

Costello AJ, Brooks M, Cole OJ (2004) Anatomical studies of the neurovascular bundles and cavernosal nerves. BJU Int 94(7):1071–1076CrossRefPubMed

35.

Tewari A, Takenaka A, Mtui E et al (2006) The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in athermal robotic technique of nerve sparing prostatectomy. BJU Int 98(2):314–323CrossRefPubMed

36.

Martinez-Pineiro L, Cansino JR, Sanchez C et al (2006) Laparoscopic radical prostatectomy. Differences between interfascial and intrafascial techniques. Eur Urol 5(suppl):331CrossRef

37.

Stolzenburg JU, Schwalenberg T, Horn LC et al (2007) Anatomical landmarks of radical prostatectomy. Eur Urol 51(3):629–639CrossRefPubMed

38.

Kiyoshima K, Yokomizo A, Yoshida T et al (2004) Anatomical features of peri-prostatic tissue and its surroundings:a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34(8):463–468CrossRefPubMed

39.

Martinez-Salamanca JI, Ramanathan R, Rao S (2008) Second Prize: pelvic neuroanatomy and innovative approaches to minimize nerve damage and maximize cancer control in patients undergoing robot-assisted radical prostatectomy. J Endourol 22(6):1137–1146CrossRefPubMed

40.

Carter S, Le JD, Hu JC (2013) Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy. Curr Opin Urol 23(1):88–94CrossRefPubMed

41.

Chauhan S, Coelho RF, Rocco B et al (2010) Techniques of nerve sparing and potency outcomes following robot assisted laparoscopic prostatectomy. Int Braz J Urol 36:259–272CrossRefPubMed

42.

Aherling TE, Eichel L, Chou D et al (2005) Feasibility study for robotic radical prostatectomy cautery free neurovascular bundle preservation. Urology 65(5):994–997CrossRef

43.

Ahlering TE, Eichel L, Skarecky D et al (2008) Evaluation of long-term thermal injury using cautery during nerve sparing robotic prostatectomy. Urology 72(6):1371–1374CrossRefPubMed

44.

Gill IS, Ukimura O (2007) Thermal energy-free laparoscopic nerve-sparing radical prostatectomy: one-year potency outcomes. Urology 70(2):309–314CrossRefPubMed

45.

Schatloff O, Chauhan S, Sivaraman A et al (2012) Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61(4):796–802CrossRefPubMed

46.

Tewari AK, Srivastava A, Huang MW (2011) Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int 108(6 Pt 2):984–992CrossRefPubMed

47.

Tewari AK, Ali A, Metgud S et al (2013) Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing. World J Urol 31(3):471–480CrossRefPubMed

48.

Schatloff O, Chauhan S, Kameh D et al (2012) Cavernosal nerve preservation during robot assisted radical prostatectomy is a graded rather than all or none phenomenon :objective demonstration by assessment of residual nerve tissue on surgical specimens. Urology 79(3):596–600CrossRefPubMed

49.

Kaul S, Savera A, Badani K et al (2006) Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int 97(3):467–472CrossRefPubMed

50.

Menon M, Shrivastava A, Kaul S et al (2007) Vattikuti Institute prostatectomy:contemporary technique and analysis of results. Eur Urol 51:648–657CrossRefPubMed

51.

Menon M, Shrivastava A, Bhandari M et al (2009) Vattikuti Institute prostatectomy:technical modifications in 2009. Eur Urol 56:89–96CrossRefPubMed

52.

Ghani KR, Trinh QD, Menon M (2012) Vattikuti Institute Prostatectomy—technique in 2012. J Endourol 26(12):1558–1565CrossRefPubMed

53.

Chien GW, Mikhail AA, Orvieto MA et al (2005) Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. Urology 66(2):419–423CrossRefPubMed

54.

Patel VR, Schatloff O, Chauhan C et al (2012) The role of the prostatic vasculature as a landmark for nerve sparing during robot assisted radical prostatectomy. Eur Urol 61:571–576CrossRefPubMed

55.

Cheetham PJ, Truesdale MD, Lee DJ (2010) Use of a flexible carbon dioxide laser fiber for precise dissection of the neurovascular bundle during robot-assisted laparoscopic prostatectomy. J Endourol 24(7):1091–1096CrossRefPubMed

56.

Schlomm T, Tennstedt P, Huxhold C et al (2012) Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nerve-sparing frequency and reduces positive surgical margins in open and robot-assisted laparoscopic radical prostatectomy: experience after 11, 069 consecutive patients. Eur Urol 62(2):333–340CrossRefPubMed

57.

Gianduzzo TR, Colombo JR Jr, Haber GP (2009) KTP laser nerve sparing radical prostatectomy: comparison of ultrasonic and cold scissor dissection on cavernous nerve function. J Urol 181(6):2760–2766CrossRefPubMed

58.

Badani KK, Shapiro EY, Berg WT et al (2013) A pilot study of laparoscopic doppler ultrasound probe to map arterial vascular flow within the neurovascular bundle during robot-assisted radical prostatectomy. Prostate Cancer 2013:810715CrossRefPubMedPubMedCentral

59.

Ukimura O, Ahlering TE, Gill IS (2008) Transrectal ultrasound-guided, energy-free, nerve-sparing laparoscopic radical prostatectomy. J Endourol 22(9):1993–1995CrossRefPubMed

60.

Joung JY, Ha YS, Singer EA et al (2013) Use of a hyaluronic acid-carboxymethylcellulose adhesion barrier on the neurovascular bundle and prostatic bed to facilitate earlier recovery of erectile function after robot-assisted prostatectomy: an initial experience. J Endourol 27(10):1230–1235CrossRefPubMedPubMedCentral

61.

Fairbairn NG, Randolph MA (2014) Redmond RW The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg 67(5):662–675CrossRefPubMed

62.

Patel VR, Samavedi S, Bates AS et al (2015) Dehydrated human amnion/chorion membrane allograft nerve wrap around the prostatic neurovascular bundle accelerates early return to continence and potency following robot-assisted radical prostatectomy: propensity score-matched analysis. Eur Urol. doi:10.1016/j.eururo.2015.01.012 (epub ahead of print)

63.

Kumar A, Samavedi S, Bates A (2015) Impact of dehydrated human amniotic membrane allograft (AmnioFix^®) on continence and potency following robot assisted radical prostatectomy. J Videourol (accepted for publication)

64.

Kumar A, Samavedi S, Bates A (2015) Using indocyanine green and near infrared fluorescence technology to identify the “landmark artery” during robot assisted radical prostatectomy. J Videourol (accepted for publication)

65.

Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy :assessment after 2766 procedures. Cancer 110(9):1951–1958CrossRefPubMed

66.

Ficcara V, Novara G, Fracalanza S et al (2009) A prospective non randomized trial comparing robot assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int 104:534–539CrossRef

67.

Rocco B, Matel DV, Melegari S et al (2009) Robotic vs open prostatectomy in a laparoscopic naïve centre: a matched pair analysis. BJU Int 5

68.

Krambeck AE, DiMarco DS, Rangel LJ et al. (2009) Radical prostatectomy for prostate adenocarcinoma : a matched comparison of open retropubic and robot assisted techniques. BJU Int 103(4):448–453CrossRefPubMed

Title: Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy
Authors: Anup Kumar
Sarvesh Tandon
Srinivas Samavedi
Vladimir Mouraviev
Anthony S. Bates
Vipul R. Patel
Publication date: 01-09-2016
Publisher: Springer London
Published in: Journal of Robotic Surgery / Issue 3/2016
Print ISSN: 1863-2483
Electronic ISSN: 1863-2491
DOI: https://doi.org/10.1007/s11701-016-0607-7

At a glance: The STEP trials

Springer Medicine

Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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