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Retrospective Concomitant Nonrandomized Comparison of "Touch" Cautery Versus Athermal Dissection of the Prostatic Vascular Pedicles and Neurovascular Bundles During Robot-assisted Radical Prostatectomy.
Hofmann, Martin; Huang, Erica; Huynh, Linda My; Kaler, Kamaljot; Vernez, Simone; Gordon, Adam; Morales, Blanca; Skarecky, Douglas; Ahlering, Thomas E.
Afiliación
  • Hofmann M; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, University of California, Irvine, CA, USA.
  • Huang E; Department of Urology, University of California, Irvine, CA, USA.
  • Huynh LM; Department of Urology, University of California, Irvine, CA, USA; MD/PhD Scholars Program, University of Nebraska Medical Center, Omaha, NE, USA.
  • Kaler K; Department of Surgery, Section of Urology, University of Calgary, Alberta, Canada.
  • Vernez S; Department of Urology, University of California, Irvine, CA, USA.
  • Gordon A; Department of Urology, University of California, Irvine, CA, USA.
  • Morales B; Department of Urology, University of California, Irvine, CA, USA; University of California, San Francisco.
  • Skarecky D; Department of Urology, University of California, Irvine, CA, USA.
  • Ahlering TE; Department of Urology, University of California, Irvine, CA, USA. Electronic address: tahlerin@uci.edu.
Eur Urol ; 81(1): 104-109, 2022 Jan.
Article en En | MEDLINE | ID: mdl-34384621
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Próstata / Robótica / Procedimientos Quirúrgicos Robotizados / Disfunción Eréctil Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans / Male Idioma: En Revista: Eur Urol Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Suiza

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Próstata / Robótica / Procedimientos Quirúrgicos Robotizados / Disfunción Eréctil Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans / Male Idioma: En Revista: Eur Urol Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Suiza