Tension and Energy-Free Robotic-Assisted Laparoscopic Radical Prostatectomy with Interfascial Dissection of the Neurovascular Bundles

Objectives: To assess overall safety, histopathological outcomes, and early functional results after robotic-assisted laparoscopic radical prostatectomy (RALP) with a new lateral approach for the interfascial dissection of the neurovascular bundles without tension and any use of electrocautery. Methods: Between April and September 2006, 100 consecutive patients with organ-confined prostate cancer (age < 70 yr, PSA ≤ 10 μg/dl, Gleason score ≤ 7, and IIEF ≥ 17) underwent RALP by the same senior surgeon. Pre-, intra-, and perioperative data were recorded. The operative technique is described step by step. Patients were assessed at the 4-mo follow-up. Results: RALP was successfully completed in all patients. Neither blood transfusions nor reintervention were necessary. One week following catheter removal, complete early urinary continence was achieved in 80% of patients, and spontaneous erections or penile tumescence was reported by 46 patients. Positive surgical margins were 12.1% in the pT2 group and 29% in the pT3 group. Ninety-three patients were available for analysis at the 4-mo follow-up. Of them, 92.4% were completely continent, 5.4% used 1 pad a day, and 2.2% used 2 or more pads a day. Concerning the IIEF-EF domain score, 64.5% of the patients reported a total score ≥ 17, and 17.2% of them scored ≥26. Conclusions: The novel approach described for RALP is safe and allows excellent dissection. It maintains good margin status and provides encouraging early continence and erectile functional results in selected patients. Long-term follow-up is necessary to assess the impact of this approach on oncological outcome. © 2007 European Association of Urology.