Extrafacial Versus Interfacial Nerve-Sparing Technique For Robotic-Assisted Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 13 Jun 2008 - 10:00 PDT

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ORLANDO, FL (UroToday.com) - The University of Chicago group evaluated the pathologic and functional outcomes of the interfacial (IF) and the extrafacial (EF) never sparing (NSP) techniques for the robotic-assisted laparoscopic radical prostatectomy (RLRP).

Utilizing a prospective data base, functional outcomes were evaluated with the UCLA-PCI (SF-36b2) questionnaire administered pre-operatively and at 1, 3, 6 and 12 months post-operatively. Among the 1225 consecutive RLRPs performed 95 and 557 men underwent bilateral EF and IF-NSP, respectively. The patients in the EF-NSP group had significantly higher clinical stage and pathologic Gleason score.

The results showed a trend toward higher pathologic staging. The overall positive surgical margin rate was 14% for EF-NSP and 19% for IF-NSP and did not differ between the two groups when stratified by clinical or pathological stage. However, the positive surgical margin rate was significantly higher for the IF group (11%) compared to the EF group (1.2%) on the left side. No significant difference was seen for the right sided positive surgical margin rates.

These investigators hypothesize that the challenge of the left sided dissection by a right handed surgeon and cross siding of the dissecting tools may account of the higher left sided positive surgical margin rate for IF-NSP compared to the EF-NSP.

There was no significant difference in terms of urinary quality of life, although, the sexual function and sexual bother score tended to be better for the IF-NSP group at six months. These observations certainly warrant further evaluation.

Presented by Sergey A. Shikanov, MD, et al., at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC

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