Evaluation of long-term thermal injury using cautery during nerve sparing robotic prostatectomy

In our initial 125 cases, we used cautery during preservation of the neurovascular bundles (NVBs). We previously reported the short-term benefit of a cautery-free versus cautery technique. To assess long-term consequences of cautery, we report 2-year potency outcomes for these robot-assisted laparoscopic radical prostatectomies (RLP).

Between June 2002 and February 2004, 125 consecutive patients underwent RLP by 1 surgeon. All data were entered prospectively into an electronic database. In cases 1 to 15, the vascular pedicle and nerve were dissected with monopolar cautery. In cases 16 to 125, the dissection used bipolar cautery and scissors. Preoperatively, 42 met inclusion criteria: age younger than 66 years, International Index of Erectile Function (IIEF-5) of 22 to 25 and uni (12) or bilateral (35) nerve sparing. Postoperatively all patients were encouraged to use 5-PDE inhibitors. Potency was assessed by self-administered validated questionnaires.

Four were excluded because of treatment intervention (3) or refusal to follow-up (1). Thirty-eight have follow-up data of 24 or more months. At 3, 9, and 15 months only 3 of 36 (8.3%), 5 of 34 (14.7%), and 16 of 37 (43.2%) were potent. However at 24+ months, 5 of 10 (50%) of unilateral and 19 of 28 bilateral nerve-sparing (68%) were potent with an average IIEF-5 of 18.4 and erectile firmness of 75% to 100% of baseline.

These findings suggest that in addition to other injury, thermal injury to the NVB is dense with very low recovery rates in the first 12 to 18 months. However, with nearly two-thirds ultimately reporting potency return, these injuries are generally not permanent and recovery approaches 75% to 100% of baseline.