Comparative Analysis of Cold Versus Thermal Dissection in Nerve-Sparing Robot-Assisted Radical Prostatectomy.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Nerve-sparing robot-assisted radical prostatectomy (nsRARP) is a key treatment for prostate cancer.
• Minimizing thermal damage to neurovascular bundles (NVBs) is crucial for preserving function.
• Cold dissection (CD) is proposed as an alternative to thermal dissection (TD) to reduce thermal injury.

Purpose of the Study:

• To compare the impact of CD versus TD on functional outcomes after nsRARP.
• To evaluate the effect of dissection technique on early urinary continence and erectile function recovery.

Main Methods:

• Prospective comparative analysis of patients undergoing nsRARP using CD and TD.
• Assessment of continence at 15, 30, and 90 days post-surgery.
• Evaluation of erectile function using the International Index of Erectile Function (IIEF-5) at 30, 90, and 180 days.

Main Results:

• CD demonstrated significantly improved early continence at 15 and 30 days (p < 0.05).
• Erectile function recovery was consistently higher in the CD group across all time points (p < 0.01).
• Advanced age negatively impacted functional recovery; high preoperative IIEF-5 scores predicted better erectile function.

Conclusions:

• CD enhances early continence and erectile function recovery following nsRARP.
• Preservation of NVBs and minimized thermal damage are key benefits of CD.
• CD represents a valuable technique for improving functional outcomes in patients undergoing prostatectomy.