Robot Assisted Radical Prostatectomy (RARP) - Nerve Sparing

Anatomical grading of nerve sparing during robot assisted radical prostatectomy is shown in the material. Erectile dysfunction following radical prostatectomy occurs secondary to injury to the central nervous, a group of parasympathetic nerves originating from the pelvic plexus and running together with arteries and veins on a prominent neuro-vascular bundle on the posterolateral aspect of the prostate. This video have demonstrated that the central nervous occupy the anteromedial aspect of the neuro-vascular bundle, closest to the prostate; whereas other nerves located laterally and inferiorly to the central nervous innervate the levator muscle and the rectum, respectively. The goal of the nerve sparing is to preserve a maximum amount of nerve tissue without compromising surgical margins. In this context, a fine tailoring is necessary to achieve the precise amount of nerve preservation neede for an individual patient. Robotic technology is a step forward in this direction, as it provides increased magnification, HD imaging and wristed instrumentation and it is associated with significantly less blood loss when compared to open surgery.