Saline‐assisted fascial exposure (SAFE) technique to improve nerve‐sparing in robot‐assisted laparoscopic radical prostatectomy

• Published in: BJU international Vol. 133; no. 4; pp. 451 - 459
• Main Authors: Pedraza, Adriana M., Gupta, Raghav, Joshi, Himanshu, Parekh, Sneha, Schlussel, Kacie, Berryhill, Roy, Kaufmann, Basil, Wagaskar, Vinayak, Gorin, Michael A., Menon, Mani, Tewari, Ashutosh K.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2024
• Subjects: erectile function; Fascia; Humans; hydrodissection; Laparoscopy; Laparoscopy - methods; Male; potency; Prostatectomy; Prostatectomy - methods; radical prostatectomy; Robotic Surgical Procedures - methods; Robotics; robot‐assisted radical prostatectomy; Saline Solution; Statistical analysis; Treatment Outcome; erectile function; potency; radical prostatectomy; hydrodissection; robot-assisted radical prostatectomy
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.16238

Objective To provide a summary of our initial experience and assess the impact of the Saline‐Assisted Fascial Exposure (SAFE) technique on erectile function (EF), urinary continence, and oncological outcomes after Robot‐Assisted Laparoscopic Radical Prostatectomy (RALP). Patients and Methods From January 2021 to July 2022, we included patients with a baseline Sexual Health Inventory for Men (SHIM) score of ≥17 and a high probability of extracapsular extension (ECE), ranging from 21% to 73%, as per the Martini et al. nomogram. A propensity score matching was carried out at a ratio of 1:2 between patients who underwent RALP + SAFE (33) and RALP alone (66). The descriptive statistical analysis is presented. The SAFE technique was performed using two approaches, transrectal guided by micro‐ultrasound or transperitoneal. Its principle entails a low‐pressure injection of saline solution in the periprostatic fascia to achieve an atraumatic dissection of the neural hammock. Potency was defined as a SHIM score of ≥17 and continence as no pads per day. Results At follow‐up intervals of 6, 13, 26, and 52 weeks, the SHIM score differed significantly between the two groups, favouring the RALP + SAFE (P = 0.01, P < 0.001, P < 0.001, and P = 0.01, respectively). These results remained significant when the mean SHIM score was assessed. As shown by the cumulative incidence curve, EF rates were higher in the RALP + SAFE compared to the RALP alone group (log‐rank P < 0.001). The baseline SHIM and use of the SAFE technique were independent predictors of EF recovery. Conclusions The use of the SAFE technique led to better SHIM scores at 6, 13, 26, and 52 weeks after RALP in patients at high risk of ECE who underwent a partial NS procedure.