Impact Of Cautery Versus Cautery-Free Preservation Of Neurovascular Bundles On Early Return Of Potency

UroToday.com - Look, But Don't Touch. This is the recommendation of this group of researchers who previously reported their initial experience with the cautery-free technique of handling the neurovascular bundle during robotic-assisted laparoscopic prostatectomy.

This report expands their experience to 51 patients who have undergone this technique in which the neurovascular bundle is dissected and clamped with laparoscopic bulldog clamps, and then oversewn for hemostasis, rather than dissected using any form of electrocautery energy.

This study's main value is in the objective data obtained from a sexual inventory (SHIM-5) score and selected questions from the EPIC-26 questionnaire to evaluate quality of life and potency. The group of 51 men undergoing robotic?assisted laparoscopic prostatectomy with unilateral or bilateral nerve sparing was compared to 36 patients who had the traditional dissection using bipolar cautery during their robotic-assisted laparoscopic prostatectomy. The two groups were comparable in their age and preoperative SHIM scores. The data was all collected prospectively via the validated questionnaires.

They found that the rate of potency at three months was 47% in the group undergoing the cautery free neurovascular bundle dissection compared to only 8.3% in the group in which bipolar cautery had been used. In addition, twice as many patients in the bipolar cautery group (68%) rated their erections at zero, compared to the cautery free group (36%).

This expanded experience with a cautery-free dissection of the neurovascular bundle during robotic-assisted laparoscopic prostatectomy supports the importance of avoiding any heat effect in this highly sensitive region for good preservation of potency. Further long-term follow-up and multi-institutional evaluation of this technique will assist in determining the durability of these results, and allow further comparison to radical retropubic prostatectomy.

T.E. Ahlering, D Skarecky, and J Borin
Journal Endourology 20(8);586-589, 2006

Reviewed by UroToday.com Medical Editor Elspeth M. McDougall, MD

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