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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. [ABSTRACT FROM AUTHOR]

Objective: A rise in temperature of more than 55 degrees C in tissues, even for short a duration has been implicated in irreversible tissue damage. This study was aimed at recording real time temperature changes at the neurovascular bundle (NVB) during the use of cautery in robotic radical prostatectomy., Methods: The temperature was monitored with a needle electrode in 15 cases of athermal nerve sparing and 10 cases of non-nerve sparing robotic radical prostatectomy (RRP). The needle was placed in the peritoneal cavity through the camera port and inserted around the NVB. Body temperature was recorded by nasal cannula and compared with the baseline temperature at the neurovascular bundle. The distance of the needle probe from the area of cautery use, changes in temperature at the neurovascular bundle and the duration of cautery use was recorded during the use of monopolar and bipolar current in tissue dissections., Results: The mean baseline temperature at the neurovascular bundle was 0.8 degrees C lower than the body temperature. Average duration for cautery use at the anterior bladder neck and NVB with monopolar and bipolar current was 53.6 (45-65) and 79.8 (70-92) and 56.8 (45-60) and 65.7 seconds (59-76) respectively. The mean temperature rise during bladder neck dissection (distance more than 1 cm) was 43.6 degrees C [36.4-47.3 degrees C] with the monopolar and 38.8 degrees C [36.8 degrees-42.6 degrees C] with bipolar. During NVB dissection, the mean temperature rise was 53.6 degrees C (45.1 to 68.1 degrees C) with monopolar and 60.91 degrees C (47.2 to 109.8 degrees C) with bipolar. Though this difference was not significant, the mean time to return to baseline temperature was 3 seconds more with bipolar than monopolar., Conclusions: Bipolar cautery may not be safer than monopolar because of a greater rise in temperature of surrounding tissues within 1 cm of its use. Further investigation is needed to fully establish the pathologic consequences associated with increased temperature due to cautery.

Robotic radical prostatectomy is fast getting popular as an alternative to the open and laparoscopic radical prostatectomy. Planning for port placement and the assistant's role are the two crucial yardsticks for the success of this procedure. Ideal port placement for radical robotic prostatectomy is not only crucial for the surgeon at the console but also for the patient side assistant. A better assistance could enhance the functional outcome of the procedure and at the same time could increase the comfort level of the surgeon at the console. This article describes the role of an assistant in robotic radical prostatectomy.