Thermal energy-free laparoscopic nerve-sparing radical prostatectomy: one-year potency outcomes

OBJECTIVES We recently described a novel, energy-free technique of nerve-sparing laparoscopic radical prostatectomy performed with transrectal ultrasound guidance. We provide Our Current technique and updated experience with 169 patients and report the potency Outcomes of this energy-free, clip-free, bioadhesive-free, nerve-sparing laparoscopic radical prostatectomy. METHODS Our technique involves transient bulldog clamping of the lateral pedicle, cold-cut release of the neurovaSCUlar bundle, and delicate hemostatic suturing. One-year follow-up data were available for 110 patients, of whom 76 (69%) had paired preoperative and 1-year postoperative Sexual Health Inventory for Men data. These 76 men included 22 patients undergoing the earlier thermal-energy based technique using an ultrasonic scalpel (group 1) and 54 patients undergoing the novel energy-free technique (group 2). RESULTS In the patients with complete potency preoperatively (Sexual Health Inventory for Men score of 22 or more), the I-year intercourse rate in groups 1 and 2 was 71% and 88%, respectively (P = 0.4), and the Sexual Health Inventory for Men score in group I versus group 2 was 5.3 versus 10.9 at 3 months (P = 0.001) and 7.5 versus 14.1 at 6 months (P = 0.02), respectively. Within the entire study group, the overall I-year intercourse rate was Superior in group 2 (36% versus 70%; P = 0.04). Erectile function recovered faster in group 2 patients. Erectile function recovery correlated significantly with preserved pulsatile blood vessels within the neUrovascular bundle (P = 0.0001) on power Doppler transrectal ultrasonography. CONCLUSIONS The elimination of electrical and thermal energy during nerve-sparing laparoscopic radical prostatectomy achieved superior and quicker potency recovery. The energy-free nervesparing technique and power Doppler- confirmed preserved pulsatile blood vessels within the neurovascular bundle correlated with superior erectile function recovery, a novel observation.