The International Journal of Medical Robotics and Computer Assisted Surgery published a study by Hatiboglu et al from the University of Heidelberg in December 2017. The double-blinded, randomized trial involved using hydrodissection to prevent trauma to neurovascular bundles in robot assisted radical prostatectomy
This randomized, double-blinded study divided 21 men undergoing radical prostatectomy for prostate cancer into two groups, those receiving standard treatment (10) and those who underwent hydrodissection first (11). The goal of the study was to determine whether gentle separation of the endopelvic fascia from Denonvilliers fascia by hydrodissection would cause less trauma to the neurovascular bundles, thereby preserving erectile function and continence. All patients were examined clinically and screened by ultrasound and thought to have localized cancer, confined within the prostatic capsule.
One half of the study goals was certainly achieved. Erectile function and the ability to have sexual intercourse recovered more quickly and in a larger percentage of patients in the hydrodissection group. Continence was not as clear cut in the early months and by 12 months postoperatively there was no significant difference. Both of these results are somewhat compromised by the inadequate number of patients in the study.
Unfortunately the study had to be terminated because pathology showed that surgical margins were positive in 5/11 of the hydrodissection group versus 1/10 in the standard treatment group, producing a p value of 0.07. Hatiboglu et al pointed out that further evaluation postoperatively determined that in the ST group 8 men were classified as pT2c and 2 as pT3a, while in the HD group 1 man was classified as pT2a, 4 as pT2c and 6 as pT3a. Thus 20% of the ST cohort was actually pT3a while 54.5% of the HD group was pT3a.
The authors stated that while the study results involving erectile function and sexual competence are encouraging, further testing would need to be done. They suggested use of multiparametric MRI evaluation in the selection process as well as frozen section done during surgery in order to avoid involving men with advanced tumor stage. Concerns were also raised about the possibility of hydrodissection creating tracks for cancer dissemination.
The goals of this study in regard to erectile function were achieved but inadequate screening of the study participants resulted in early termination.
Bibliography
1. Guru, Khurshid A.; Perlmutter, Adam E.; Butt, Zubair M.; Peabody, James O.; “Hydrodissection for preservation of neurovascular bundle during robot-assisted radical prostatectomy”; The Canadian Journal of Urology; 15(2); April 2008.
2. Hatiboglu, G.; Simpfendorfer, T.; Uhlmann, L.; Begero, M.A.; Macher-Goeppinger, S.; Pahernik, S.; Hadaschik, B; Hohenfellner, M.; Teber, D.; “A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy.”; International Journal of Medical Robotics; 13(4); December 2017.
3. Parekattil, Sijo J.; Dahm, Philipp; Vieweg, Johannes W.; “Hemostatic Hydrodissection of the Neurovascular Bundles during Robotic Assisted Laparoscopic Radical Prostatectomy – Safety & Efficacy Trial”; Proceedings of SPIE – The International Society for Optical Engineering; 7161; February 2009.
4. Wenger, Hannah; Razmaria, Aria; Eggener, Scott; Raman, Jay D.; “Nerve Bundle Hydrodissection and Sexual Function after Robot Prostatectomy”; Journal of the Society of Laparoendoscopic Surgeons; 21(4) Oct-Dec 2017.
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