Background

During robotic-assisted radical prostatectomy (RARP), the use of electrocautery near the neurovascular bundles (NVBs) frequently results in thermal injury to the cavernous nerves. The cut and “touch” monopolar cautery technique has been suggested to reduce desiccating thermal injury caused by bipolar energy when vessels are sealed.

Objective

To compare potency outcomes between an athermal technique (AT) and touch cautery (TC) to transect the prostatic vascular pedicles (PVPs) and dissect the NVBs.

Design, setting, and participants

A retrospective concomitant nonrandomized study of AT versus TC was performed in 733 men. A total of 323 undergoing AT had “thin” pedicles, easily suitable for suture ligation. TC was based on “thick” pedicles (n = 230) difficult to suture ligate. Men were excluded for an International Index of Erectile Function (IIEF-5) score of <15 or adjuvant therapies (n = 180).

Surgical procedure

Single-surgeon RARP.

Measurements

Patient-reported outcomes with erectile function (EF) recovery defined as two affirmative answers to erections sufficient for intercourse (ESI; “are erections firm enough for penetration?” and “are the erections satisfactory?”), IIEF-5 scores 15–25, and a novel percent fullness score comparing pre- versus postoperative erection fullness. Logistic regression models assessed the correlation between cautery technique, covariates, and EF recovery.

Results and limitations

In an unadjusted analysis, preoperative IIEF-5, age, body mass index (BMI), and prostate weight were significant predictors of potency recovery. Follow-up was similar (AT 52.7 mo vs TC 54.6 mo, p = 0.534). In logistic regression, preoperative IIEF-5, age, and BMI were significant predictors of EF recovery, defined as IIEF-5 scores 15–25, ESI, and percent fullness >75%. Results were similar when IIEF-5 and percent fullness were assessed continuously.

Conclusions

During transection of the PVPs and dissection of the NVBs, TC did not impact EF recovery significantly, compared with an AT.

Patient summary

Electrocautery can be applied safely, with similar outcomes to those of an athermal technique.

中文翻译：

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机器人辅助根治性前列腺切除术中前列腺血管蒂和神经血管束“触摸”烧灼与非热解剖的回顾性伴随非随机比较

背景

在机器人辅助根治性前列腺切除术 (RARP) 期间，在神经血管束 (NVB) 附近使用电灼经常会导致海绵状神经受到热损伤。有人建议使用切割和“触摸”单极烧灼技术来减少密封容器时由双极能量引起的干燥热损伤。

客观的

比较无热技术 (AT) 和触摸烧灼 (TC) 横切前列腺血管蒂 (PVP) 和解剖 NVB 的效力结果。

设计、设置和参与者

在 733 名男性中进行了一项关于 AT 与 TC 的回顾性伴随非随机研究。共有 323 名接受 AT 的患者有“薄”蒂，很容易适合缝合结扎。TC 基于 难以缝合结扎的“厚”椎弓根 ( n = 230)。男性被排除在国际勃起功能指数 (IIEF-5) 评分 <15 或辅助治疗 ( n  = 180) 之外。

外科手术

单外科医生 RARP。

测量

患者报告的勃起功能 (EF) 恢复结果定义为对足以进行性交的勃起的两​​个肯定回答（ESI；“勃起是否足够牢固，可以穿透？”和“勃起是否令人满意？”），IIEF-5 评分 15-25 ，以及一个比较勃起前和术后勃起丰满度的新百分比丰满度评分。逻辑回归模型评估了烧灼技术、协变量和 EF 恢复之间的相关性。

结果和局限性

在未经调整的分析中，术前 IIEF-5、年龄、体重指数 (BMI) 和前列腺重量是效力恢复的重要预测因素。随访相似（AT 52.7 mo vs TC 54.6 mo，p  = 0.534）。在逻辑回归中，术前 IIEF-5、年龄和 BMI 是 EF 恢复的重要预测因子，定义为 IIEF-5 评分 15-25、ESI 和饱胀百分比 >75%。当持续评估 IIEF-5 和饱腹度百分比时，结果相似。

结论

在 PVP 的横断和 NVB 的解剖过程中，与 AT 相比，TC 对 EF 恢复没有显着影响。

患者总结

电灼可以安全地应用，其结果与无热技术相似。