The neurovascular structure‐adjacent frozen‐section examination (NeuroSAFE) approach to nerve sparing in robot‐assisted laparoscopic radical prostatectomy in a British setting – a prospective observational comparative study

Objectives To evaluate the NeuroSAFE technique in a British setting in men undergoing RALP. Patients and Methods We retrospectively analysed our prospectively maintained database of patients who underwent RALP between Nov 2008 and Feb 2017. We examined preoperative pathological and functional parameters, intra-operative nerve sparing, post-operative histology as well as functional and oncological follow-up. We compared those who had a NeuroSAFE approach and those who had nerve sparing without NeuroSAFE. We also compared all the RALPs before and after the introduction of NeuroSAFE. Statistical analysis was done using the two tailed T-test and Chi-Squared analysis. Results This single surgeon series included 417 RALPs including 120 NeuroSAFEs. The NeuroSAFE cohort had a greater proportion of D'Amico high risk disease (30.8% vs 9.6%, p<0.0001), higher Gleason scores and higher pT stage compared to the non-NeuroSAFE nerve spares. After the introduction of NeuroSAFE, more preoperatively potent men underwent bilateral nerve sparing with pT2 disease (84.6% vs. 66.3%, p=0.002) and more overall nerve spares were performed in patients with pT3 disease (65.1% vs 36.7%, p=0.012). Overall positive surgical margin rates (PSMR) were lower in the NeuroSAFE cohort compared to those who had nerve sparing without NeuroSAFE (9.2% vs 17.8%, p=0.04). The 12-months potency rates were also higher in the NeuroSAFE cohort for both bilateral (77.3% vs 50.9% p=0.009) and unilateral (70.6% vs 40%, p=0.04) nerve spares. Pad-free continence was also higher in the NeuroSAFE group (85.7% vs 70.9%, p=0.019), but there was no significant difference between those who were wearing 1 safety pad or less. Although we only had short term oncological follow-up, it did not significantly differ between the two groups. Conclusions Adoption of NeuroSAFE allowed us to offer nerve sparing in higher risk patients, whilst reducing PSMR and at the same time improving potency at 12 months. This article is protected by copyright. All rights reserved.