Department of Urology, National Health Insurance Corporation Ilsan Hospital, Goyang, South Korea.
BJU Int. 2013 Mar;111(3):451-8. doi: 10.1111/j.1464-410X.2012.11393.x. Epub 2012 Aug 20.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Incremental nerve-sparing techniques (NSTs) improve postoperative erectile function after robot-assisted radical prostatectomy (RARP). However, there are no studies to date that histologically confirm the surgeon intended NST. Thus, in the present study, we histologically confirmed that the surgeon performed the nerve preservation as his intended NSTs during RARP. Also, we found that there was more variability in fascia width outcome on the left side compared with the right. Therefore, when performing nerve preservation on the surgeon's non-dominant side, we need to pay more close attention.
To confirm that the surgeon achieved true intended histological nerve sparing during robot-assisted radical prostatectomy (RARP) by studying RP specimens. To aid the novice robotic surgeon to develop the skills of RARP.
Between June 2008 and May 2009, 122 consecutive patients underwent RARP by a single surgeon (K.K.B.). The degree of nerve sparing (wide resection [WR], interfascial nerve sparing [ITE-NS], intrafascial nerve sparing [ITR-NS]) on both sides was recorded. The posterior sectors of RP specimens from distal, mid, and proximal parts were evaluated. Fascia width (FW) of each position in RP specimens were compared across nerve-sparing types (NSTs). FW was recorded at 15 ° intervals (3-9 o'clock position), measured as the distance between the outermost prostate gland and surgical margin. The slides were reviewed by an experienced uropathologist who was 'blinded' to the NST.
In all, 93 men were included. The overall mean (sd) FW was the greatest in the order of WR, ITE-NS, and ITR-NS, at 2.42 (1.62), 1.71 (1.40) and 1.16 (1.08) mm, respectively (P < 0.001). FW was statistically significantly correlated with the surgical technique used. When the surgeon intended to perform various levels of nerve sparing, these were reflected in the FW. Interestingly, the left-side FW showed more variability than the right side. We suspect that this was a result of the surgeon's right-hand dominance. Erectile function (EF) recovery rate according to NST was 88.9%, 77.3%, 65.6%, 56.3%, and 0% in bilateral ITR-NS, ITR-NS/ITE-NS, bilateral ITE-NS, ITE-NS/WR, and bilateral WR, respectively. To further validate and confirm these preliminary findings, additional studies involving multicentre cohorts would be required.
The surgeon intended dissection and FW correlate, with ITR-NS providing the narrowest FW and the EF recovery rate was the highest in bilateral ITR-NS. There was more variability in FW outcome on the left side than the right. The novice robotic surgeon should consider this variability when performing RARP. It may have implications for technique improvement on nerve preservation for EF.
通过研究前列腺根治性切除术（RARP）标本，确认外科医生在机器人辅助前列腺根治性切除术（RARP）中实现了真正的、预期的组织学神经保留。帮助新手机器人外科医生掌握 RARP 技能。
2008 年 6 月至 2009 年 5 月，连续 122 例患者由同一位外科医生（KKB）行 RARP。记录双侧神经保留程度（广泛切除[WR]、筋膜间神经保留[ITE-NS]、筋膜内神经保留[ITR-NS]）。评估前列腺标本的后区，取自远端、中部和近端。比较 RARP 标本各部位的筋膜宽度（FW）在神经保留类型（NST）之间的差异。FW 在 15°间隔（3-9 点位置）记录，测量方法为最外侧前列腺与手术边缘之间的距离。由一位经验丰富的泌尿科病理学家进行阅片，阅片时对 NST 进行“盲法”。
共纳入 93 例男性。总体平均（标准差）FW 依次为 WR、ITE-NS 和 ITR-NS 最大，分别为 2.42（1.62）、1.71（1.40）和 1.16（1.08）mm（P<0.001）。FW 与所使用的手术技术呈统计学显著相关。当外科医生打算进行不同程度的神经保留时，这些都会反映在 FW 中。有趣的是，左侧 FW 的变异性大于右侧。我们怀疑这是由于外科医生右手为主导手所致。根据 NST，勃起功能（EF）恢复率分别为双侧 ITR-NS、ITR-NS/ITE-NS、双侧 ITE-NS、ITE-NS/WR 和双侧 WR 为 88.9%、77.3%、65.6%、56.3%和 0%。为了进一步验证和确认这些初步发现，需要进行涉及多中心队列的额外研究。
外科医生预期的解剖和 FW 相关，ITR-NS 提供最窄的 FW，双侧 ITR-NS 的 EF 恢复率最高。左侧 FW 的结果变异性大于右侧。新手机器人外科医生在进行 RARP 时应考虑到这种变异性。这可能对 EF 神经保护的技术改进有影响。
