Nuances in nerve sparing during robotic assisted radical prostatectomy

INTRODUCTION AND OBJECTIVES: We have previously published our work identifying anatomical landmarks for grading of nerve sparing. We now demonstrate further nuances in nerve preservation during Robotic assisted Radical Prostatectomy. METHODS: The present study is a combination of a single surgeon experience after 5000 patients and a compilation of videos detailing some possible scenarios that surgeons might face when performing nerve sparing. RESULTS: Case 1: 55 year old man with PSA of 5, SHIM score 25, DRE reveals T1c with and low volume disease. Complete bilateral nerve sparing is performed. Case 2: 60 year old man with SHIM score of 25, PSA of 7.2, and normal DRE. During the dissection of NVB, the surgeon initially misses the correct plane then correcting it to proceed Vol. 189, No. 4S, Supplement, Monday, May 6, 2013 THE JOURNAL OF UROLOGY e521 more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins. CONCLUSIONS: Nerve sparing should be tailored according to the patient’s preoperative pathology as well as intraoperative tissue characteristics. Surgeon’s experience plays a key part. Preoperative pathology and intraoperative visual cues as well as attention to tissue planes are paramount to achieve good outcomes.