V08-09: High anterior release of neurovascular bundle by hydrodissection during robotic assisted radical prostatectomy: technique and short-term outcomes
Preservation of the neurovascular bundle during radical prostatectomy is extremely important for positive surgical margin rate and functional outcomes. This study evaluated the outcomes of high anterior release of neurovascular bundle by hydrodissection (H-HARNVB) during robot assisted laparoscopic radical prostatectomy (RALP).
Between June and October 2017, 25 patients underwent H-HARNVB (Group 1) were matched-paired with a cohort of 25 patients who underwent standard bilateral nerve sparing RALP (group 2). We compared demographic, operative, oncologic and functional outcomes between these two groups. In this video we describe the procedure of hydrodissection of the neurovascular bundles using ERBE Jet 2 equipment.After ligation of the dorsal venous complex, hydrodissection fluid Sodium chloride is injected under 40 bar in the tissue plane just outside the prostate capsule. The injection started at 1 and 11 o’clock of prostate which was anterior to the location of the neurovascular bundles. After the injection, the dissection is immediately done with a combination of sharp and gentle blunt dissection, allowing the neurovascular bundles to be released more anterior and lateral. With the pressure of dissection, expanded tissue planes were separate from the firm prostate capsule and create a facilitated dissection plane around the posterolateral surface of the prostate. The remaining steps, including single running-suture vesicourethral anastomosis, have been described in detail.
Patient profile, operative parameters, oncologic and functional outcomes are shown in table 1. In patients with H-HARNVB mean SHIM scores were higher than in the standard dissection group by 2.1 at 3 months (p
Satisfactory functional outcomes were achieved by high anterior release of neurovascular bundle with hydrodissection during robotic assisted radical prostatectomy. Longer follow-up is needed to evaluate direct impact of hydrodissection on outcomes in patients after RALP.