Nerve-sparing procedures during robot-assisted radical prostatectomy (RARP) have demonstrated improved postoperative functional outcomes. This article provides an overview of clinically applied prostatic neuro-anatomy, various techniques of nerve sparing (NS), and recent innovations in NS and potency outcomes of NS RARP. We retrieved and reviewed all listed publications within PubMed using keywords: nerve sparing, robotic radical prostatectomy, prostate cancer, outcomes, pelvic neuroanatomy and potency. Studies reporting potency outcomes of NS RARP (comparative and non-comparative) were analysed using the Delphi method with an expert panel of urological robotic surgeons. Herein, we outline the published techniques of NS during RARP. Potency and continence outcomes of individual series are discussed in light of the evidence provided by case series and published trials. The potency outcomes of various comparative and non-comparative series of NS RARP have also been mentioned. There are numerous NS techniques reported for RARP. Each method is complimented with benefits and constrained by idiosyncratic caveats, and thus, careful patient selection, a wise intraoperative clinical judgment and tailored approach for each patient is required, when decision for nerve sparing is made. Further large prospective multi-institutional randomized controlled trials are required to evaluate potency and continence outcomes of these techniques, using a rigid standard patient selection criteria and definition of potency are warranted in the new era of functional outcome-driven research.

Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy

Nerve-sparing robot-assisted radical prostatectomy: Current perspectives

Introduction:Indocyanine green (ICG) is a fluorescent molecule that provokes detectable photon emission. The use of ICG with near-infrared (NIR) imaging system (Akorn, Lake Forest, IL) has been des...

Robot-assisted nerve-sparing radical prostatectomy using near-infrared fluorescence technology and indocyanine green: initial experience.

Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. Over the past 18 years, we have performed 13,000 radical prostatectomies, and our surgical technique has evolved over time. We discuss this evolution and how it has helped us achieve optimal patient outcomes.

Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases

Radical prostatectomy remains an important means to treat prostate cancer A major limiting factor to radical prostatectomy is short- and long-term complications, especially incontinence and sexual dysfunction With the advent of robotic radical prostatectomy, the ability to easily evaluate technical issues with video has been realized In this article, we present a step-by-step examination of our procedure and our results over the past 5 years

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Robot-Assisted Radical Prostatectomy: A Step-by-Step Guide.

Introduction and Objectives: The “Landmark Artery” has been shown to be a valuable landmark during nerve-sparing (NS) robot assisted radical prostatectomy (RARP) in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes, this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. We performed the first ever study to evaluate the role of an innovative intraoperative tool, near-infrared fluorescence (NIRF) technology in conjunction with intravenous indocyanine green (ICG) in identification of this “Landmark Artery” during NS RARP. We demonstrate our technique in this video. Methods: Ten patients underwent NS RARP. Before clamping the pedicle or dissection of the NVB, 0.75 ml of ICG was given. The NIRF technology was engaged on the robotic console and a period of 20–40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period, we switched back to the non-NI...

Using Indocyanine Green and Near-Infrared Fluorescence Technology to Identify the “Landmark Artery” During Robot-Assisted Radical Prostatectomy

Objective: We demonstrate various tips and tricks, including latest innovations to improve neurovascular bundles preservation and their outcomes during robot-assisted radical prostatectomy...

Tips and Tricks to Improve Neurovascular Bundles Preservation During Robot-Assisted Radical Prostatectomy

Objective: In this video, we demonstrate the innovative role of instant toggling of endoscope in key steps of nerve sparing (NS), modified posterior reconstruction, and vesicourethral anas...

Innovative Application of Instant Toggling of Endoscope in Challenging Cases During Robot-Assisted Radical Prostatectomy Using Xi da-Vinci Robotic Surgical System

R PatelVipul

Papers

Using Indocyanine Green and Near-Infrared Fluorescence Technology to Identify the “Landmark Artery” During Robot-Assisted Radical Prostatectomy

Tips and Tricks to Improve Neurovascular Bundles Preservation During Robot-Assisted Radical Prostatectomy

Innovative Application of Instant Toggling of Endoscope in Challenging Cases During Robot-Assisted Radical Prostatectomy Using Xi da-Vinci Robotic Surgical System