A recent multicenter study found that specific techniques used during robotic-assisted radical prostatectomy may influence a patient’s ability to regain erectile function 1-year postsurgery.
Investigators analyzed surgical videos from 157 patients who were surgically treated by 28 surgeons at five hospitals in the United States and Germany. They focused on the nerve-sparing step of the procedure, which is often critical for preserving erectile function. All of the patients had adequate sexual function prior to surgery and were followed-up for 12 months.
From more than 80,000 annotated surgical movements, the investigators identified patterns in tissue handling. The patients whose surgeons used a higher proportion of “peel/push” gestures—delicate movements to separate tissue—were more likely to recover erectile function. This association remained significant after adjusting for patient age and the extent of nerve preservation.
In contrast, certain actions were associated with lower recovery rates. These included applying heat energy or using grasping gestures on the neurovascular bundle, the nerves responsible for erectile function. Patients exposed to more of these gestures were less likely to report functional recovery at 1 year.
The study also evaluated technical skill using a validated scoring system. Higher scores in tissue handling, measured on a three-point scale, were associated with improved outcomes. Patients whose surgeons received the highest tissue handling scores had a greater likelihood of recovering erectile function.
Patient characteristics also played a role in outcomes. Younger age, smaller prostate volume, and full nerve preservation were each associated with higher recovery rates. Overall, 34% of the patients regained erections sufficient for intercourse at 1 year.
Surgeon experience, defined by prior case volume, wasn't linked to recovery. Some surgeons had performed more than 10,000 prostate surgeries, yet experience didn't predict better outcomes. However, more experienced surgeons were more likely to use specific gesture types such as cold-cutting and coagulation.
The investigators also found differences in surgical behavior based on the extent of nerve preservation. Surgeons performing partial preservation more often used energy and retraction gestures on the nerves, which may further impact recovery chances.
The findings suggested that surgical performance—measured through gesture type and technical skill—can help predict long-term patient outcomes. Analyzing intraoperative data may provide opportunities to improve surgical technique and support better recovery.
The investigators noted that this approach could be applied to other procedures to better understand how surgical technique affects patient-reported outcomes.
Full disclosures are available in the published study.
Source: JAMA Surgery