V11-07: Prostatic Artery Preservation (PAP): A Novel Technique for Robotic Assisted Radical Prostatectomy
Oncologic control without untoward effects on patient continence or potency remains the goal of robotic assisted radical prostatectomies (RARPs). Prostatic artery preservation (PAP) during Retzius-sparing RARP is a novel technique aimed at preserving the lateral prostatic arteries and, as a result, the perfusion to the neurovascular bundle. Rather than clipping these arteries as they course through the posterior-lateral pedicles, the arteries are preserved within the interfascial plane by ligating more distal perforating arterial branches as they enter the prostate. The ultimate goal is to maintain perfusion to the veil of spared nerves and thus improve rates of post-procedure continence and potency. This video serves as a tool to describe the technique and to review our early experience and outcomes.
PAP was developed by a single surgeon (KJ). Patients who underwent RARP with PAP from March 2018 until August 2018 were identified. Retrospective chart review was performed to collect demographics, operative details, staging and clinical outcomes for each patient. The International Consultation on Incontinence Modular Questionnaire - Urinary Continence Short Form (ICIQ-UC SF) and the Sexual Health Inventory for Men (SHIM) were used to assess pre-operative and 6-week post-operative urinary continence and erectile function.
Twenty-one patients who underwent RARP with PAP were identified. Fifteen underwent bilateral PAP and 6 underwent unilateral PAP. Mean age and BMI were 60 years and 27.28, respectively. Mean operative time was 168 minutes and mean estimated blood loss was 129 cc. There were no complications. At 6 weeks post-procedure, the mean decrease in SHIM was 12 (54%) in patients who underwent unilateral PAP and 4.7 (25%) in those who had bilateral PAP. Of patients with adequate pre-op erections (SHIM >17), 2/6 (33%) and 6/10 (60%) had erections sufficient for intercourse at 6 weeks post-op for unilateral and bilateral PAP respectively. All 15 patients who had bilateral PAP and 4/6 (66%) patients who had unilateral PAP were using 0 pads per day. Average increase in ICIQ-UC SF post-operatively was 2.4/21 for unilateral PAP and 1.3/21 for bilateral PAP.
The RARP with PAP represents a novel approach to the robotic prostatectomy with promising early return of post-operative continence and erectile function. Longer term follow-up and further technical refinement is warranted given these encouraging outcomes.