Preservation of continence and potency after Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) are two key outcome measures that patients consider when comparing different treatment options for localized prostate cancer. Ensuring that positive surgical margins are as low as possible provides oncologic control. Various techniques to optimize these outcomes have been employed. This study presents the early outcomes for Hemostatic Hydrodissection of the Neurovascular Bundles during 86 consecutive RALPs. Positive margin rates were 12.5% overall (9% for pT2 and 28.6% for pT3); continence at 6 months was 100%, at 3 months 90% and at 1 month 66%. In patients with no preoperative erectile dysfunction (preoperative SHIM of 25), 79% had return of erections sufficient for intercourse by 6 months. 2 of these patients were able to have intercourse 2 weeks after surgery. These preliminary findings appear promising.
Our goal was to develop a robotic approach for vasoepididymostomy (RAVE) and vasovasostomy (RAVV) using a 4 arm High Definition Platform (Intuitive Surgical, CA) and present our human in-vivo results. All 3 RAVV procedures were successful and one patient had 102 million motile sperm/ml of ejaculate at 1 month post-op. The RAVE procedure patient only had a few non-motile sperm at 6 month follow up in his ejaculate. The use of robotics seems to offer advantages in terms of ergonomics and suture control. Further evaluation is needed to assess the clinical potential of robotics in vasectomy reversal.
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