Cancer control and the preservation of neurovascular tissue: how to meet competing goals during robotic radical prostatectomy

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Abstract
Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To present early functional and oncological data for the athermal trizonal nerve‐sparing technique of robotic radical prostatectomy (RP), that addresses the concerns about deviations from the principles of open RP and revisits the anatomical foundations of this surgery from the robotic perspective. PATIENTS AND METHODS The study involved close collaboration between the Cornell Institute of Robotic Surgery in New York, USA, and the Institute of Urology at the University of Innsbruck in Austria. The cadaveric studies and standardization of the athermal technique were conducted at Innsbruck, and the technique was used in 215 patients in New York. RESULTS The athermal technique addresses concerns about the use of thermal energy and bulldog clamps during nerve sparing, and emphasizes the importance of the trizonal neural architecture. We analysed the surgical outcomes of 215 consecutive patients from January 2005. The operative duration was 120–240 min and the mean blood loss was 150 mL. In patients potent before RP the potency rate at 1 year after bilateral nerve‐sparing was 87%. The overall surgical margin rate was 6.5% and positive margin rates for organ‐confined cancer were 4.7%. CONCLUSION We describe the athermal technique of robotic RP and introduce the concept of trizonal nerve preservation. The immediate oncological and sexual outcomes were encouraging.