Review of Neurovascular Reconstruction During Robotic-Assisted Laparoscopic Radical Prostatectomy

This manuscript provides a narrative review of techniques of neurovascular reconstruction during robotic-assisted laparoscopic radical prostatectomy (RALP).

Historic techniques of neurovascular reconstruction, including autologous nerve grafting and neurorrhaphy, have been shown to be feasible in patients in early pilot studies. More recently, perinatal tissue allografts have been studied, with studies supporting earlier recovery of potency or continence. We review historic experimental techniques which are less frequently employed, including nerve grafting and end-to-end nerve anastomosis. More recently, perinatal tissue allograft wraps placed over the neurovascular bundles (NVB) have been demonstrated to be feasible, requiring minimal additional operative time. Existing studies demonstrate earlier return to potency or continence for men with good preoperative function. While further prospective research is needed to validate these findings, this represents a feasible method which may accelerate recovery for men undergoing RALP.