Case report: Fluorescence-guided laparotomic radical prostatectomy with heightened nerve visualization.

Area of Science:

• Urology
• Surgical Technology
• Nerve Sparing Surgery

Background:

• Radical prostatectomy can lead to iatrogenic injury of the cavernous nerve, resulting in erectile dysfunction in up to 85% of patients.
• Preserving the cavernous nerve is crucial for maintaining post-operative sexual function.

Observation:

• A novel fluorescence-imaging system utilizing near-ultraviolet light (NUVL) was employed during a radical prostatectomy.
• The system enhanced the visualization of the periprostatic nerve plexus, including the cavernous nerve and its branches, through autofluorescence.
• Under NUVL, nerves fluoresced brightly, allowing for clear identification and avoidance during surgery.

Findings:

• The fluorescence imaging system facilitated clear visualization of the cavernous nerve and its branches, which were not visible under standard white light.
• The surgical team successfully avoided nerve injury during the prostatectomy.
• The patient experienced no intra-operative or post-operative complications, including erectile dysfunction or voiding difficulties, at one-month follow-up.

Implications:

• Intra-operative nerve autofluorescence may be a valuable tool for reducing iatrogenic nerve injury during radical prostatectomies.
• This technology holds promise for improving functional outcomes, such as preventing erectile dysfunction, after prostate surgery.
• Further research with larger patient cohorts and comparative trials is warranted to validate the effectiveness of this novel imaging technique.