Laser nerve-sparing laparoscopic radical prostatectomy: a feasibility study

Objective To examine, in a pilot study, the feasibility of laser dissection of the neurovascular bundle (NVB) during nerve-sparing laparoscopic radical prostatectomy (NSLRP). NSLRP demands precise NVB mobilization with minimal collateral tissue trauma and optimal haemostasis. Unlike other methods of delivering energy, lasers have the potential to provide rapid, precise dissection with good haemostasis and minimal adjacent tissue injury. Patients and Methods Five patients were treated with NSLRP; in patient 1 the right NVB was dissected using clips and scissors and the left NVB using the 1064 nm Nd:YAG laser (8 W, continuous-wave mode). In the subsequent four patients, the NVB was dissected bilaterally using the laser. The NVBs were excised for histological analysis. Results In patient 1, the estimated blood loss for the left (laser) NVB dissection was 20 mL, while the estimated blood loss for the right NVB was 100 mL. The maximum depth of laser necrosis was 327 mu m. For the next four patients the mean (range) total operative duration was 214 (166-245) min, the mean NVB dissection time 22 (8-33) min, the mean total blood loss 213 (100-300) mL, the mean estimated NVB blood loss 28 (10-45) mL and the mean depth of tissue injury was 687 mu m. There were no complications. There was no recurrence, as assessed by prostate-specific antigen levels, at a mean follow-up of 12 months and all patients were continent. Conclusion Laser NSLRP was relatively straightforward and caused minimal blood loss, allowed a rapid dissection and minimal adjacent tissue injury. It is a promising technique that warrants further evaluation.