During robotic-assisted radical prostatectomy (RARP), the use of electrocautery near
the neurovascular bundles (NVBs) frequently results in thermal injury to the cavernous
nerves. The cut and “touch” monopolar cautery technique has been suggested to reduce
desiccating thermal injury caused by bipolar energy when vessels are sealed.
To compare potency outcomes between an athermal technique (AT) and touch cautery (TC)
to transect the prostatic vascular pedicles (PVPs) and dissect the NVBs.
Design, setting, and participants
A retrospective concomitant nonrandomized study of AT versus TC was performed in 733
men. A total of 323 undergoing AT had “thin” pedicles, easily suitable for suture
ligation. TC was based on “thick” pedicles (n = 230) difficult to suture ligate. Men were excluded for an International Index of
Erectile Function (IIEF-5) score of <15 or adjuvant therapies (n = 180).
Patient-reported outcomes with erectile function (EF) recovery defined as two affirmative
answers to erections sufficient for intercourse (ESI; “are erections firm enough for
penetration?” and “are the erections satisfactory?”), IIEF-5 scores 15–25, and a novel
percent fullness score comparing pre- versus postoperative erection fullness. Logistic
regression models assessed the correlation between cautery technique, covariates,
and EF recovery.
Results and limitations
In an unadjusted analysis, preoperative IIEF-5, age, body mass index (BMI), and prostate
weight were significant predictors of potency recovery. Follow-up was similar (AT
52.7 mo vs TC 54.6 mo, p = 0.534). In logistic regression, preoperative IIEF-5, age, and BMI were significant
predictors of EF recovery, defined as IIEF-5 scores 15–25, ESI, and percent fullness
>75%. Results were similar when IIEF-5 and percent fullness were assessed continuously.
During transection of the PVPs and dissection of the NVBs, TC did not impact EF recovery
significantly, compared with an AT.
Electrocautery can be applied safely, with similar outcomes to those of an athermal