Journal of Robotic Surgery

, Volume 3, Issue 1, pp 13–17

Athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy

  • Geoffrey Coughlin
  • Pankaj P. Dangle
  • Kenneth J. Palmer
  • Srinivas Samevedi
  • Vipul R. Patel
Original Article

DOI: 10.1007/s11701-009-0127-9

Cite this article as:
Coughlin, G., Dangle, P.P., Palmer, K.J. et al. J Robotic Surg (2009) 3: 13. doi:10.1007/s11701-009-0127-9

Abstract

While cancer control is the primary objective of radical prostatectomy, maintenance of sexual function is a priority for the majority of men presenting with prostate cancer. Preservation of the neurovascular bundles is the challenging and critical step of radical prostatectomy with regards to maintenance of potency. The objective of this study is to describe the surgical steps of our hybrid technique: athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy. This technique involves releasing the neurovascular bundle in a retrograde direction from the apex toward the base of the prostate, during an antegrade prostatectomy. It is a hybrid of the traditional open and the laparoscopic approaches to nerve sparing. With this approach we are able to clearly delineate the path of the bundle and avoid inadvertently injuring it when controlling the prostatic pedicle. Our hybrid nerve-sparing technique combines aspects of the traditional open anatomical approach with those of the laparoscopic antegrade approach. The benefits of robotic technology allow a retrograde neurovascular bundle dissection to be performed during an antegrade radical prostatectomy.

Keywords

Robotic-assisted laparoscopic prostatectomy (RALP)Nerve sparingFunctional outcomesRobotic prostatectomy

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Copyright information

© Springer-Verlag London Ltd 2009

Authors and Affiliations

  • Geoffrey Coughlin
    • 1
  • Pankaj P. Dangle
    • 2
  • Kenneth J. Palmer
    • 3
  • Srinivas Samevedi
    • 4
  • Vipul R. Patel
    • 5
  1. 1.Department of Urology, Global Robotics InstituteFlorida Hospital Celebration Health, University of Central FloridaOrlandoUSA
  2. 2.The James Cancer CenterOhio State UniversityColumbusUSA
  3. 3.Department of Urology, Global Robotics Institute Latin AmericaFlorida Hospital Celebration Health, University of Central FloridaOrlandoUSA
  4. 4.Global Robotics InstituteFlorida Hospital Celebration HealthOrlandoUSA
  5. 5.Department of Urology, Global Robotics Institute and Urologic Oncology ProgramFlorida Hospital Celebration Health, University of Central FloridaOrlandoUSA