In this study, 268 men underwent RARP with the surgeon and the assistant exerting traction and countertraction on the NVB to clearly elucidate the intrafascial plane and to achieve better preservation of the NVB. The technique was modified after Walsh was observed performing a RARP in which assistant intervention was minimized. Another 342 men subsequently underwent RARP with this modified technique. The two groups are compared in terms of expected blood loss, operative times, and positive surgical margins (PSMs) as well as functional outcomes using Expanded Prostate Index Composite (EPIC) sexual function and potency scores at 5 mo and 12 mo postoperation. Minimizing physical detraction between the prostate and the NVB resulted in a modest increase in blood loss but not in operating times or PSMs and resulted in significantly superior EPIC sexual function scores at 5 mo postop.
Despite these improvements, however, it must be borne in mind that the primary goal of RARP is cancer control. Although erectile function remains a key functional outcome, surgical refinements toward nerve preservation must be assessed carefully in the context of their oncologic outcome. Although assistance may not be necessary in exerting countertraction of the NVB, the assistant should not be lulled into a sense of complacency and should be actively involved in identification, retraction, mobilization, and preservation of various structures encountered not just in RARP but in all robotic procedures. Subtle operative interventions such as “reduction of countertraction” cannot be measured objectively. Their impact is best judged in hindsight, years after they have been implemented. Only then do their effects become truly manifest. Importantly, data must always be collected prospectively and evaluated independently to maintain objectivity and to avoid bias that may occur when this review is done by the same surgical team. This paper attains this standard.
Conflicts of interest
The authors have nothing to disclose.
-  J.A. Eastham, M.W. Kattan, E. Rogers, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156:1707-1713
-  J.U. Stolzenburg, R. Rabenalt, M. Do, A. Tannapfel, M.C. Truss, E.N. Liatsikos. Nerve sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique. J Endourol. 2006;20:925-929 Crossref.
-  J.-U. Stolzenburg, T. Schwalenberg, L.-C. Horn, J. Neuhaus, C. Constantinides, E.N. Liatsikos. Anatomical landmarks of radical prostatectomy. Eur Urol. 2007;51:629-639 Abstract, Full-text, PDF, Crossref.
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