V6-08: NEUROVASCULAR BUNDLE PRESERVATION IN ROBOT-ASSISTED RADICAL PROSTATECTOMY: A VARIATION OF THE ANTEROGRADE TECHNIQUE.
VideoIntroductions and Objectives
The Robot-Assisted Radical Prostatectomy (RARP) has commonly dissected the neurovascular bundle by anterograde approach, either inside the fascia or outside. In the Open Radical Prostatectomy (ORP), the nerve-sparring technique commonly uses the retrograde dissection. In the RARP the retrograde approach is no used, because of the risk of rectum injury, due to scope limitations in the angle of view. In the RARP the Seminal Vesicle (SV) dissection is also by anterograde approach, same as in the ORP. However when SV dissection is performed by posterior approach and it is dissected until the apex is reached, it is possible to perform a retrograde preservation with 30-grades scope view, without risk of rectum injury. This technique has never been described.
A single Robot-assisted Radical Prostatectomy with the technique description, and neurovascular preservation is presented, using the Da Vinci SI Surgical System. Technique for posterior approach of the SV and retrograde dissection of the neurovascular bundle with 30-grade angle scope is explained.
No damage or injury to the neurovascular bundle was performed, allowing complete neural integrity and functionality.
The RARP requires a proper training, which consolidates over time, as the number of cases increases. Urologists are more familiar with retrograde nerve preservation, because of their access on the open surgery. The posterior dissection of the SV completely frees the prostate from rectum, preserving the innervation without risk of damaging the rectum. We believe that this variation allows a better conservation and more appropriate handling by the surgeon, as it is more trained in this surgical approach.