Karolinska Robotic Prostatectomy Functional Outcomes Andreas Nilsson

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Karolinska Robotic Prostatectomy Functional
OutcomesAndreas Nilsson
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• Does the tecnical advances with the robotic
  system, enhanced visualization of the operating
  field and endowrist function, translate into
  improved functional outcome?

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Continence data after 3, 6 and 12 months, all
surgeons from case 1 to 595
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Percent of patients that have no pads or pads for
security reasons only, case 1 to 595
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Potency data 12 months after surgery for all
patients operated at Karolinska with DvP

• Potency defined as having successful sexual
  penetration in at least half of attempts with or
  without the use of PDE-inhibitors.
• - 57.5 after bilateral nerve sparing
• - 52.1 after unilateral nerve sparing

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Wide variation between surgeons concerning
potency results

• 87 able to perform sexual penetration after
  either bi or unilateral nerve sparing for one of
  the surgeons
• Compared to
• 37 able to perform sexual penetration after
  bilateral nerve sparing for an other surgeon

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• The discrepancy is best explained by technical
  aspects and not by patient selection
• Use of electrical cautery during the dissection
  of the NVB
• Correct anatomical plane of dissection

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Different dissection options for preservation or
resection of NVB
Interfascial plane
Intrafascial plane
Extrafascial plane
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Interfascial plane
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Interfascial plane
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Seminerve sparing
Seminerve sparing
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• Potency data for one surgeon three, six and
  twelve months after robot-assisted laparoscopic
  radical prostatectomy. Defined as ability to have
  successful sexual penetration in at least half of
  attempts with or without the use of
  PDE-inhibitors.

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Oncological data for the different approches of
nervesparing
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Conclusions

• The robotic system has the capacity for a
  excellent functional outcome but the system has
  to be utilized in an optimal fashion
• - No thermal energy close to the NVB
• - Recognition of the correct anatomical
  plane of dissection