Mediathek

Igloo-technique for robot-assisted radical prostatovesiculectomy (RARP): maximum nerve sparing for early recovery of continence and sexual function

Schlagworte: Diagnostik
04.11.2021Deutsch

Abstract

Igloo-technique for robot-assisted radical prostatovesiculectomy (RARP): maximum nerve sparing for early recovery of continence and sexual function

C. Malkmus1, F. Aschwanden1, J. Cornelius1, P. Viktorin1, P. Baumeister1, L. Mordasini1, A. Mattei1
1Luzerner Kantonsspital, Klinik für Urologie, Luzern, Schweiz

Introduction: Preservation of the anatomical suspension of the prostate including the neurovascular structures might accelerate early continence and erectile function rates. Here we present a complete circumferential intrafascial dissection technique with a single lateral approach in RARP for low-risk prostate cancer: the Igloo-technique.
Methods:
Operation was standardized into 10 steps
1.    Exposition of right lateral prostate
2.    Incision of endo-/periprostatic fascia
3.    Mobilization of right neurovascular bundle
4.    Dissection of seminal vesicles and dorsal prostate plane
5.    Dissection of bladder neck
6.    Mobilization of left neurovascular bundle
7.    Mobilization of dorsal venous complex
8.    Dissection of apex
9.    Vesico-urethral-anastomosis
10.    Closure of endopelvic fascia
Results: 10 patients underwent Igloo-technique since March 2020. Median operation time was 197min [160-316min]. Transurethral catheter was removed in median at 3rd [3-11d] postoperative day (POD). Postoperative histology showed pT2a (n=2), pT2c (n=6), pT3a (n=1), pT3b (n=1). Low and intermediate risk Gleason scores were confirmed in 9 of 10 patients. In 2 cases positive surgical margins (0,5-2mm, Gleason 3) were found. Early continence was evaluated using pad tests. In the first 24h after catheter removal the median loss was 5,5g/24h [0-25g/24h]. At 10th POD and 12 weeks control dry pads were reported. 12 weeks postoperatively a median IIEF-15 of 52,5 points [27-65] was achieved using PDE-5-inhibitors.
Conclusion: The Igloo-technique as a complete circumferential nerve sparing with a single lateral approach is feasible, safe but technically demanding. Excellent early continence and midterm erectile function can be achieved. Nevertheless, the Igloo-technique is only to be used for patients with low-risk-profile cancer.

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