Mp73-20 Where to Start Your Nerve-Sparing in Robotic-Assisted Radical Prostatectomy: Lateral Prostatic Fascia Versus Prostatic Pedicle

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (MP73)1 May 2024MP73-20 WHERE TO START YOUR NERVE-SPARING IN ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: LATERAL PROSTATIC FASCIA VERSUS PROSTATIC PEDICLE Runzhuo Ma, Eman Dadashian, Alvin C. Goh, Geoffrey A. Sonn, Christian Wagner, Andrew J. Vickers, Jim C. Hu, and Andrew Hung Runzhuo MaRunzhuo Ma , Eman DadashianEman Dadashian , Alvin C. GohAlvin C. Goh , Geoffrey A. SonnGeoffrey A. Sonn , Christian WagnerChristian Wagner , Andrew J. VickersAndrew J. Vickers , Jim C. HuJim C. Hu , and Andrew HungAndrew Hung View All Author Informationhttps://doi.org/10.1097/01.JU.0001009564.26544.1c.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Identifying the anatomic nerve-sparing (NS) plane poses challenges, especially for training surgeons. Although various techniques exist, there is limited comparative outcomes. In this study, we assessed various approaches from surgeons at multiple centers and compared efficiency and erectile function (EF) recovery. METHODS: We included 20 surgeons at 4 international medical centers, who submitted 42 NS robotic radical prostatectomy videos. Footage of NS was annotated to identify the exact moment when the intended dissection plane was first observed and from which point the dissection plane was maintained. Two distinct approaches were identified (Fig. 1): (1) lateral prostatic fascia approach (n=14 by 5 surgeons) – where NS begins from the anterior aspect of the prostate by incision into the lateral prostatic fascia, developing the dissection plane until the neurovascular bundle (NVB) is separated from the prostate. (2) prostatic pedicle approach (n=28 by 18 surgeons) – where NS begins from the prostatic vascular pedicles, progressing antegrade medial to the NVB to find the dissection plane where the prostate separates from the NVB. Three surgeons used both approaches. The duration and number of surgical gestures to reach this moment were compared by bootstrapping methods stratified by surgeons to account for data clustering. EF was followed up at 1 year. RESULTS: Baseline patient characteristics (e.g., age, baseline EF, comorbidities) were similar. The duration and number of gestures leading to the identification of the NS dissection plane were, for the lateral prostatic fascia approach, a median of 1.6 mins (95% CI 1.2 – 2.0 mins) and a median of 77 gestures (95% CI 58 - 100), compared to the prostatic pedicle approach, a median of 4.4 mins (95% CI 3.6 - 5.3 mins) and a median of 114 (95% CI 98 - 134) gestures (p<0.001 for duration; p=0.011 for gestures). The 1-year EF recovery rate was 43% for the lateral prostatic fascia approach and 46% for the prostatic pedicle approach (p=0.83, Chi-square test). CONCLUSIONS: The lateral prostatic fascia approach was more efficient in identifying the anatomic NS dissection plane compared to the prostatic pedicle approach, while EF recovery at 1 year was similar. More exposure to lateral prostatic fascia approach may benefit training surgeons. Download PPT Source of Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA273031. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1190 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Runzhuo Ma More articles by this author Eman Dadashian More articles by this author Alvin C. Goh More articles by this author Geoffrey A. Sonn More articles by this author Christian Wagner More articles by this author Andrew J. Vickers More articles by this author Jim C. Hu More articles by this author Andrew Hung More articles by this author Expand All Advertisement PDF downloadLoading ...