Gianduzzo Troy R J, Colombo Jose R, Haber Georges-Pascal, Magi-Galluzzi Cristina, Dall'Oglio M F, Ulchaker James, Gill Inderbir S
Center for Laparoscopic and Robotic Surgery, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Urol. 2009 Jun;181(6):2760-6. doi: 10.1016/j.juro.2009.01.095. Epub 2009 Apr 17.
Energy sources used during nerve sparing radical prostatectomy are known to compromise cavernous nerve function. Lasers offer the potential for accurate dissection while minimizing collateral injury to delicate neural structures. We evaluated cavernous nerve function following KTP laser dissection and compared outcomes to those of ultrasonic shears and cold scissor dissection.
Laparoscopic unilateral neurovascular bundle mobilization was performed in 36 survival dogs using a KTP laser, ultrasonic shears and an athermal technique with cold scissors and clips in 12 each. Peak intracavernous pressure upon cavernous nerve stimulation, expressed as a percent of mean arterial pressure, was measured acutely and at 1 month. Thermal spread from the KTP laser and ultrasonic shears was assessed histologically ex vivo in harvested peritoneum.
Median peak intracavernous pressure as a percent of mean arterial pressure was similar immediately and 1 month after laser and athermal dissection, and significantly decreased after dissection with ultrasonic shears. Acute peak intracavernous pressure as a percent of mean arterial pressure was 53%, 96% and 98% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.51, ultrasonic shears vs laser p <0.001 and ultrasonic shears vs athermal p <0.001). Chronic peak intracavernous pressure as a percent of mean arterial pressure was 56%, 98% and 100% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.38, ultrasonic shears vs laser p = 0.016 and ultrasonic shears vs athermal p = 0.013). The median depth of acute laser injury was 600 microm compared to 1.2 mm for ultrasonic shear dissection and 450 microm crush injury due to the athermal technique. Thermography revealed less collateral thermal spread from the laser than from the ultrasonic shears (median greater than 60C thermal spread 1.07 vs 6.42 mm, p <0.01).
The KTP laser was comparable to the athermal technique and superior to the ultrasonic shears for preserving cavernous nerve function.
已知在保留神经的根治性前列腺切除术中使用的能量源会损害海绵体神经功能。激光能够在精确解剖的同时，将对脆弱神经结构的附带损伤降至最低。我们评估了在使用磷酸钛钾（KTP）激光解剖后海绵体神经的功能，并将结果与超声刀和冷剪刀解剖的结果进行比较。
对36只存活犬进行腹腔镜下单侧神经血管束游离术，其中12只分别使用KTP激光、超声刀以及采用冷剪刀和钛夹的非热技术。在海绵体神经受到刺激时测量海绵体内峰值压力，并以平均动脉压的百分比表示，分别在术后即刻和术后1个月进行测量。通过对采集的腹膜进行离体组织学评估，来测定KTP激光和超声刀的热扩散情况。
以平均动脉压的百分比表示的海绵体内峰值压力中位数，在激光和非热解剖术后即刻及1个月时相似，而在使用超声刀解剖后显著降低。以平均动脉压的百分比表示的急性海绵体内峰值压力，超声刀组为53%，激光组为96%，非热技术组为98%（激光组与非热技术组相比，p = 0.51；超声刀组与激光组相比，p <0.001；超声刀组与非热技术组相比，p <0.001）。以平均动脉压的百分比表示的慢性海绵体内峰值压力，超声刀组为56%，激光组为98%，非热技术组为100%（激光组与非热技术组相比，p = 0.38；超声刀组与激光组相比，p = 0.016；超声刀组与非热技术组相比，p = 0.013）。急性激光损伤的深度中位数为600微米，而超声刀解剖为1.2毫米，非热技术造成的挤压伤为450微米。热成像显示，激光造成的附带热扩散比超声刀少（热扩散超过60℃的中位数，激光组为1.07毫米，超声刀组为6.42毫米，p <0.01）。
在保留海绵体神经功能方面，KTP激光与非热技术相当，且优于超声刀。
