Results of Using a New Technology to Improve the Identification and Preservation of Nerve Tissue during Robotic-Assisted Laparoscopic Radical Prostatectomy

Introduction & Objectives
Efforts to improve continence after robotic-assisted laparoscopic radical prostatectomy (RALRP) have focused on preserving periurethral and bladder neck tissue and techniques involving posterior reconstructions and anterior suspensions. Many patients, however, still have varying degrees of urinary incontinence. Literature has shown that nerves innervating the levator ani (LA) contribute to continence and anatomic landmarks are not accurate in determining their location. Inadvertent damage to these nerves may therefore contribute to post RALRP incontinence.

Intra-operative identification of nerve tissues using a stimulated EMG produces a waveform known as a compound motor action potential (CMAP) and is standard of care in brain, spine, and facial surgery. The Author used a new technology that elicits and records CMAP’s during RALRP and evaluated the ability to identify and preserve the nerves innervating the LA.