KTP Laser Nerve Sparing Radical Prostatectomy: Comparison of Ultrasonic and Cold Scissor Dissection on Cavernous Nerve Function

No AccessJournal of UrologyInvestigative Urology1 Jun 2009KTP Laser Nerve Sparing Radical Prostatectomy: Comparison of Ultrasonic and Cold Scissor Dissection on Cavernous Nerve Function Troy R.J. Gianduzzo, Jose R. Colombo, Georges-Pascal Haber, Cristina Magi-Galluzzi, M.F. Dall'Oglio, James Ulchaker, and Inderbir S. Gill Troy R.J. GianduzzoTroy R.J. Gianduzzo , Jose R. ColomboJose R. Colombo , Georges-Pascal HaberGeorges-Pascal Haber , Cristina Magi-GalluzziCristina Magi-Galluzzi , M.F. Dall'OglioM.F. Dall'Oglio , James UlchakerJames Ulchaker , and Inderbir S. GillInderbir S. Gill View All Author Informationhttps://doi.org/10.1016/j.juro.2009.01.095AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Energy sources used during nerve sparing radical prostatectomy are known to compromise cavernous nerve function. Lasers offer the potential for accurate dissection while minimizing collateral injury to delicate neural structures. We evaluated cavernous nerve function following KTP laser dissection and compared outcomes to those of ultrasonic shears and cold scissor dissection. Materials and Methods: Laparoscopic unilateral neurovascular bundle mobilization was performed in 36 survival dogs using a KTP laser, ultrasonic shears and an athermal technique with cold scissors and clips in 12 each. Peak intracavernous pressure upon cavernous nerve stimulation, expressed as a percent of mean arterial pressure, was measured acutely and at 1 month. Thermal spread from the KTP laser and ultrasonic shears was assessed histologically ex vivo in harvested peritoneum. Results: Median peak intracavernous pressure as a percent of mean arterial pressure was similar immediately and 1 month after laser and athermal dissection, and significantly decreased after dissection with ultrasonic shears. Acute peak intracavernous pressure as a percent of mean arterial pressure was 53%, 96% and 98% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.51, ultrasonic shears vs laser p <0.001 and ultrasonic shears vs athermal p <0.001). Chronic peak intracavernous pressure as a percent of mean arterial pressure was 56%, 98% and 100% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.38, ultrasonic shears vs laser p = 0.016 and ultrasonic shears vs athermal p = 0.013). The median depth of acute laser injury was 600 μm compared to 1.2 mm for ultrasonic shear dissection and 450 μm crush injury due to the athermal technique. Thermography revealed less collateral thermal spread from the laser than from the ultrasonic shears (median greater than 60C thermal spread 1.07 vs 6.42 mm, p <0.01). Conclusions: The KTP laser was comparable to the athermal technique and superior to the ultrasonic shears for preserving cavernous nerve function. References 1 : Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. J Urol2004; 172: 1318. Link, Google Scholar 2 : Laser nerve-sparing laparoscopic radical prostatectomy: a feasibility study. BJU Int2007; 99: 875. Google Scholar 3 : Comparative study of different laser systems. Fertil Steril1994; 61: 581. Google Scholar 4 : In vitro tissue effects of a combined Ho:YAG/Nd:YAG laser: sprinkling of tissue fragments by Ho:YAG laser light may be problematic for oncological interventions. Lasers Surg Med1999; 25: 396. Google Scholar 5 : Intraoperative electrical stimulation of cavernous nerves with monitoring of intracorporeal pressure to confirm nerve sparing during radical prostatectomy: early clinical results. Int J Urol2003; 10: 251. Google Scholar 6 : Effects of hyperthermia on the peripheral nervous system: a review. Int J Hyperthermia2004; 20: 371. Google Scholar 7 : Experimental study on heat production by a 23.5-kHz ultrasonically activated device for endoscopic surgery. Surg Endosc1999; 13: 621. Google Scholar Center for Laparoscopic and Robotic Surgery, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio© 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 6June 2009Page: 2760-2766 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsprostatenerve tissuelasersprostatectomysolid-stateMetricsAuthor Information Troy R.J. Gianduzzo More articles by this author Jose R. Colombo More articles by this author Georges-Pascal Haber More articles by this author Cristina Magi-Galluzzi More articles by this author M.F. Dall'Oglio More articles by this author James Ulchaker Financial interest and/or other relationship with American Medical Systems. More articles by this author Inderbir S. Gill Financial interest and/or other relationship with Hansen Medical. More articles by this author Expand All Advertisement PDF downloadLoading ...