Retrospective Concomitant Nonrandomized Comparison of Touch Cautery Versus Athermal Dissection of the Prostatic Vascular Pedicles and Neurovascular Bundles During Robot-assisted Radical Prostatectomy

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). 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. (c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Automated summary

This study compared the impact of athermal technique (AT) and touch cautery (TC) on erectile function recovery during radical prostatectomy. The results showed that during transection of prostatic vascular pedicles and dissection of neurovascular bundles, TC did not significantly affect erectile function recovery compared to AT.