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Ma R, Cen S, Forsyth E, Probst P, Asghar A, Townsend W, Hui A, Desai A, Tzeng M, Cheng E, Ramaswamy A, Wagner C, Hu JC, Hung AJ. Technical surgical skill assessment of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy. JU OPEN PLUS 2023; 1:e00039. [PMID: 38187460 PMCID: PMC10768840 DOI: 10.1097/ju9.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Purpose To examine the association between the quality of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy. Materials and Methods Patients who underwent RARPs from 2016 to 2018 in two institutions with ≥1-year postoperative follow-up were included. The primary outcomes were time to urinary continence recovery. Surgical videos were independently assessed by 3 blinded raters using the validated Dissection Assessment for Robotic Technique (DART) tool after standardized training. Cox regression was used to test the association between DART scores and urinary continence recovery while adjusting for relevant patient features. Results 121 RARP performed by 23 surgeons with various experience levels were included. The median follow-up was 24 months (95% CI 20 - 28 months). The median time to continence recovery was 7.3 months (95% CI 4.7 - 9.8 months). After adjusting for patient age, higher scores of certain DART domains, specifically tissue retraction and efficiency, were significantly associated with increased odds of continence recovery (p<0.05). Conclusions Technical skill scores of neurovascular bundle dissection vary among surgeons and correlate with urinary continence recovery. Unveiling the specific robotic dissection skillsets which impact patient outcomes has the potential to focus surgical training.
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Affiliation(s)
- Runzhuo Ma
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Steven Cen
- Department of Radiology, University of Southern California, Los Angeles, California
| | - Edward Forsyth
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Patrick Probst
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Aeen Asghar
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - William Townsend
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Alvin Hui
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Aditya Desai
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
| | - Michael Tzeng
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Emily Cheng
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Ashwin Ramaswamy
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Christian Wagner
- Department of Urology and Urologic Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Andrew J. Hung
- Center for Robotic Simulation & Education, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, California
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Kyriazis I, Spinos T, Tsaturyan A, Kallidonis P, Stolzenburg JU, Liatsikos E. Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes. Cancers (Basel) 2022; 14:cancers14071601. [PMID: 35406373 PMCID: PMC8996922 DOI: 10.3390/cancers14071601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Optimum preservation of potency and continence after radical prostatectomy (RP) are equally important surgical endpoints as cancer control itself. Nerve-sparing technique during RP has a major impact to both oncological and functional outcomes of the procedure and various different techniques have been developed aiming to optimize its outcomes. This literature review aims to summarize all different nerve-sparing techniques applied during RP from its first description from Patrick C. Walsh to its newer trends. The review underlines that optimum nerve-sparing expands far beyond recognising and preserving the anatomical integrity of the neurovascular bundles. It also emphasises that nerve-sparing is a field under constant development, with new technologies entering continuously the nerve-sparing field corresponding to the evolving open, laparoscopic and robotic-assisted RP approaches. Abstract The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.
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Affiliation(s)
- Iason Kyriazis
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Theodoros Spinos
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Arman Tsaturyan
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Correspondence: ; Tel.: +30-2610-999-386
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