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Review
. 2021 Jan;8(1):2-13.
doi: 10.1016/j.ajur.2020.05.012. Epub 2020 Jun 11.

Nerve-sparing robot-assisted radical prostatectomy: Current perspectives

Anup Kumar  1 , Vipul R Patel  2 , Sridhar Panaiyadiyan  3 , Kulthe Ramesh Seetharam Bhat  2 , Marcio Covas Moschovas  2 , Brusabhanu Nayak  3
Affiliations
Review

Nerve-sparing robot-assisted radical prostatectomy: Current perspectives

Anup Kumar et al. Asian J Urol. 2021 Jan.

Abstract

Robotic-assisted radical prostatectomy (RARP) is the current standard of care with long term cure in organ-confined disease. The introduction of nerve-sparing (NS) to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes. This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes, the neurovascular bundle (NVB), various NS techniques and postoperative functional outcomes. A non-systematic review was done using PubMed, Embase and Medline databases to retrieve and analyse articles in English, with following keywords "prostate cancer", "robotic radical prostatectomy", "nerve-sparing". The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies. The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other. Variables such as preoperative risk assessments, baseline potency, surgical anatomy of individual patients and surgeons' expertise play a major role in the outcomes. A tailored approach for each patient is required for applying the NS approach during RARP.

Keywords: Nerve-sparing; Prostatectomy; Robot-assisted radical prostatectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Landmark artery on anterolateral aspect of prostate.
Figure 2
Figure 2
Left retrograde dissection towards the base of the prostate to completely detach the NVB from the prostatic pedicle. NVB, neurovascular bundle.
Figure 3
Figure 3
dHAM placed over as right sided nerve wrap on NVB. dHACM, dehydrated human amnion/chorion membrane; NVB, neurovascular bundles.
Figure 4
Figure 4
Landmark artery seen as green fluorescent structure over lateral surface of prostate in near infrared fluorescence mode.
See this image and copyright information in PMC

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