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 1-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 1 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 1-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 nerve-sparing technique and power Doppler-confirmed preserved pulsatile blood vessels within the neurovascular bundle correlated with superior erectile function recovery, a novel observation.