The Role of the Prostatic Vasculature as a Landmark for Nerve Sparing During Robot-Assisted Radical Prostatectomy

Patel, Vipul R.; Schatloff, Oscar; Chauhan, Sanket; Sivaraman, Ananthakrishnan; Valero, Rair; Coelho, Rafael F.; Rocco, Bernardo; Palmer, Kenneth J.; Kameh, Darian

doi:10.1016/j.eururo.2011.12.047

« Previous Next »European Urology
Volume 61, Issue 3 , Pages 571-576, March 2012

The Role of the Prostatic Vasculature as a Landmark for Nerve Sparing During Robot-Assisted Radical Prostatectomy

Vipul R. Patel
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
- University of Central Florida School of Medicine, Orlando, FL, USA
- Corresponding author. 410 Celebration Place, Suite 200, Celebration, FL 34747, USA.
Oscar Schatloff
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
Sanket Chauhan
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
- University of Central Florida School of Medicine, Orlando, FL, USA
Ananthakrishnan Sivaraman
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
Rair Valero
- Hospital Universitario de Caracas, Caracas, Venezuela
Rafael F. Coelho
- Hospital Israelita Albert Einstein, São Paulo, Brazil
Bernardo Rocco
- Sezione di Urologia, Università degli Studi di Milano, Milan, Italy
- Present address: Dipartimento di Scienze Chirurgiche Specialistiche, Sezione di Urologia – Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Kenneth J. Palmer
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
- University of Central Florida School of Medicine, Orlando, FL, USA
Darian Kameh
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA

Accepted 20 December 2011. published online 03 January 2012.

Abstract

Background

Macroscopic landmarks are lacking to identify the cavernosal nerves (CNs) during radical prostatectomy. The prostatic and capsular arteries run along the lateral border of the prostate and could help identify the location of the CNs during robot-assisted radical prostatectomy (RARP).

Objective

Describe the visual cues that have helped us achieve consistent nerve sparing (NS) during RARP, placing special emphasis on the usefulness of the prostatic vasculature (PV).

Design, setting, and participants

Retrospective video analysis of 133 consecutive patients who underwent RARP in a single institution between January and February 2011.

Surgical procedure

NS was performed using a retrograde, antegrade, or combined approach.

Measurements

A landmark artery (LA) was identified running on the lateral border of the prostate corresponding to either a prostatic or capsular artery. NS was classified as either medial or lateral to the LA. The area of residual nerve tissue on surgical specimens was measured to compare the amount of NS between the groups.

Results and limitations

We could identify an LA in 73.3% (195 of 266) of the operated sides. The area of residual nerve tissue was significantly different whether the NS was performed medial (between the LA and the prostate) or lateral to the LA (between the LA and pelvic side wall): median (interquartile range) of 0 (0–3) mm² versus14 (9–25) mm²; p<0.001, respectively.

Conclusions

The PV is an identifiable landmark during NS. Fine tailoring on the medial border of an LA can consistently result in a complete or almost complete NS, whereas performing the NS on its lateral border results in several degrees of incomplete NS.

Take Home Message

The prostatic vasculature is a reliable cue for identifying the neurovascular bundles during robot-assisted radical prostatectomy. Nerve sparing medial to the prostatic vasculature consistently results in complete or almost complete nerve preservation.

Keywords: Robot assisted radical prostatectomy, Prostate cancer, Nerve sparing