Anatomic Grading of Nerve Sparing During Robot-Assisted Radical Prostatectomy

Schatloff, Oscar; Chauhan, Sanket; Sivaraman, Ananthakrishnan; Kameh, Darian; Palmer, Kenneth J.; Patel, Vipul R.

doi:10.1016/j.eururo.2011.12.048

« Previous Next »European Urology
Volume 61, Issue 4 , Pages 796-802, April 2012

Anatomic Grading of Nerve Sparing During Robot-Assisted Radical Prostatectomy

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
Darian Kameh
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
Kenneth J. Palmer
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA
- University of Central Florida School of Medicine, Orlando, FL, USA
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 Pl, Suite 200, Celebration, FL 34747, USA.

Accepted 23 December 2011. published online 05 January 2012.

Abstract

Background

Because of the lack of intraoperative visual cues, the amount of nerve sparing (NS) intended by the surgeon does not always correspond to what is actually performed during surgery.

Objective

Describe a standardized NS grading system based on intraoperative visual cues.

Design, setting, and participants

A total of 133 consecutive patients who underwent robot-assisted radical prostatectomy (RARP) by a single surgeon were evaluated. The surgeon intraoperatively graded the NS independently for either side as follows: 1=no NS; 2=<50% NS; 3=50% NS; 4=75% NS; 5=≥95% NS.

Surgical procedure

RARP; detailed description of a five-point NS grading system.

Measurements

The area of residual nerve tissue on prostatectomy specimens was compared with the intraoperative NS score (NSS). The rate of positive surgical margins (PSMs) according to the NSS is also reported.

Results and limitations

In all, 52.6% of operated sides (140 of 266 sides) had NSS 5, 30.1% (80 of 266) had NSS 4, 2.3% (6 of 266) had NSS 3, 13.2% (35 of 266) had NSS 2, and 1.9% (5 of 266) had NSS 1. The area of residual nerve tissue was significantly different among the different NSSs: median area (interquartile range) for NSS 5: 0.5 (0–2) mm²; for NSS 4: 3 (0–8) mm²; for NSS 3: 13 (7–23) mm²; for NSS 2: 14 (8–24) mm²; and for NSS 1: 57 (56–165) mm² (p<0.001). Overall, 9.02% of the patients (12 of 133 patients) had a PSM, with 8.3% (9 of 108) for pT2 and 12% (3 of 25) for pT3. Side-specific PSMs according to NSS were 3.6% (5 of 140) for NSS 5, 7.5% (6 of 80) for NSS 4, 16.7% (1 of 6) for NSS 3, 5.7% (2 of 35) for NSS 2, and 0% (0 of 5) for NSS 1. A limitation of our study is that the key anatomic landmarks are not recognizable in every case, and this technique might not be easy to perform during the early learning curve.

Conclusions

We believe that the visual cues exposed in this article will help surgeons achieve more consistent NS during RARP.

Take Home Message

The advantages for visualization, magnification, and dexterity provided by the robotic platform allow identification of key anatomic landmarks that can be used to perform more tailored and consistent nerve sparing during radical prostatectomy.

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