Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes

Sci Rep. 2020 Oct 19;10(1):17595. doi: 10.1038/s41598-020-74513-y.

Abstract

Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). The clipless intrafascial neurovascular bundle-sparing technique aims to preserve periprostatic structures and neurovascular bundles as much as possible by avoiding clipping of the vascular pedicles. This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundle-sparing RARP. Intact erectile function was defined as score ≥ 21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse. Median follow-up was 26.5 months (IQR 15.25-48). Postoperative erectile function recovery rates were 71.4%, 81.9%, 88.6%, 92.4%, and 94.3% at 1, 3, 6, 9, and 12 months, respectively. The rate of positive surgical margins was 16.2% overall and 11.8% in patients with stage pT2 disease. The biochemical recurrence rate was 6.7% overall. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Further large-scale prospective comparative studies are warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Erectile Dysfunction / etiology*
  • Humans
  • Male
  • Middle Aged
  • Penile Erection / physiology
  • Postoperative Complications / etiology
  • Prostate / pathology
  • Prostate / surgery*
  • Prostatectomy / adverse effects
  • Prostatectomy / methods*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / surgery*
  • Recovery of Function
  • Robotic Surgical Procedures / adverse effects
  • Robotic Surgical Procedures / methods*
  • Treatment Outcome