Transrectal ultrasound guided nerve sparing daVinci Prostatectomy (dVP). Advantages and disadvantages on feasibility evaluation.

Abstract

In this video we report one case of Nerve Sparing dVP using Real-time TRUS guide. We used a biplane ultrsound probe on a 58 years old patient with t1c gleason 6 (3+3) Low risk prostate cancer. An intrafascial bilateral nerve sparing radical prostatectomy with a tension energy free technique is perfomed. The patient has been discharged at day 2 with a pentafecta result. We registered some disadvantages due to the presence of the rectal probe for the posterior dissection on the median line. Moreover for the nerve sparing dissection the neuro vascular bundel (NVB) has been hold in place by the probe and no traction on the NVB has been done. The dissection has to be performed releasing the prostate from the bindle instead of the bundle from the prostate. When crossing pedicles were encountered they were tested with the bipolar forceps to follow the doppler signal in order to not clip and transect significant vessels of the NVB. TRUS guided dVP is an effective and safe procedure and could provide adjunctive informations during nerve sparing procedures in order to obtain an optimal vascular preservation of the NVB.