Saline-assisted fascial exposure (SAFE) technique to improve nerve-sparing in robot-assisted laparoscopic radical prostatectomy.

Autor: Pedraza AM; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Gupta R; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Joshi H; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Parekh S; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Schlussel K; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Berryhill R; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Kaufmann B; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Wagaskar V; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Gorin MA; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Menon M; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Tewari AK; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Apr; Vol. 133 (4), pp. 451-459. Date of Electronic Publication: 2023 Dec 28.
DOI: 10.1111/bju.16238
Abstrakt: Objective: To provide a summary of our initial experience and assess the impact of the Saline-Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot-Assisted Laparoscopic Radical Prostatectomy (RALP).
Patients and Methods: From January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro-ultrasound or transperitoneal. Its principle entails a low-pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day.
Results: At follow-up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log-rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery.
Conclusions: The use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.
(© 2023 BJU International.)
Databáze: MEDLINE
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