Robotic Radical Prostatectomy - STEP 7- Non-nerve Sparing Technique

The following video will highlight the technique of robotic non-nerve preservation (wide prostate dissection). This is video 7 of 10 in a series focused on robotic radical prostatectomy for localized prostate cancer.

Occasionally, due to cancer related factors (Gleason score, PSA, digital rectal exam, clinal stage, number and percentage of biopsy cores), the surgeon may perform a wider resection away from the prostate capsule due to a high liklihood of extracapsular disease. We routinely use the Kattan Memorial Sloan Kettering prostate cancer nomogram to counsel our patient's risk of extracapsular disease.

A positive surgical margin (PSM) occurs when prostate cancer cells are observed at the edge of the specimen, impyling that cancer cells remain in the patient. This pathological finding increases the risk of disease recurrence identified by a detectable and rising PSA after surgery. A PSM is the only recurrence risk factor that is related to the surgeon and his technique. The most important factor to minimize this risk is surgical experience. There is a litany of data to suppor that surgeon "expertise" defined as a surgeon who has performed more than 300 robotic procedures leads to the optimal cancer-free outcomes. As such, we generally counsel patients seeking robotic surgery to search for a surgeon with over 250-300 case experience.
Surgeon experience is also a major factor in complications, potency and continence.