Next-Generation Nerve-Sparing Techniques in Robotic Radical Prostatectomy: A Contemporary Review.

IF 2.9 2区 医学 Q2 UROLOGY & NEPHROLOGY
Brandon Piyevsky, Alina Gandrabur, Paige Bird, David I Lee, Mohammad Shahait, Ryan W Dobbs
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Abstract

Purpose of review: To summarize the evolution and future of technologies and techniques that assist in providing good functional outcomes during nerve-sparing robot-assisted radical prostatectomy.

Recent findings: Recent data underscore the value of preoperative optimization, including structured weight loss and pharmacologic interventions such as GLP-1 receptor agonists, in facilitating safer and more precise nerve-sparing. Advances in imaging and surgical planning, including 3D modeling and augmented reality, have enhanced anatomic visualization and margin control. Intraoperative adjuncts such as frozen section analysis (NeuroSAFE), nerve mapping and fluorescence guidance are being evaluated to minimize neural injury. Next-generation robotic systems incorporating haptic feedback and intraoperative penile oxygen monitoring may provide real-time functional assessment. Early series suggest these technologies can improve early continence and potency recovery, though long-term validation is needed. The future of nerve-sparing prostatectomy lies in a precision-based, multimodal framework that integrates advanced imaging, intraoperative functional assessment, and patient-specific rehabilitation strategies. While robotic surgery has established a new benchmark for anatomic preservation hold promise for improving both oncologic and quality-of-life outcomes. Rigorous validation and standardized reporting will be critical to moving these innovations from investigational use into routine practice.

机器人根治性前列腺切除术中的下一代神经保留技术:当代综述。
综述的目的:总结在保留神经的机器人辅助根治性前列腺切除术中提供良好功能结果的技术和技术的发展和未来。最近的发现:最近的数据强调了术前优化的价值,包括有组织的减肥和药物干预,如GLP-1受体激动剂,在促进更安全和更精确的神经保留方面。成像和手术计划的进步,包括3D建模和增强现实,增强了解剖可视化和边缘控制。术中辅助手段,如冷冻切片分析(NeuroSAFE)、神经定位和荧光引导正在被评估,以尽量减少神经损伤。结合触觉反馈和术中阴茎氧监测的下一代机器人系统可能提供实时功能评估。早期研究表明,这些技术可以改善早期尿失禁和药力恢复,但需要长期验证。保留神经的前列腺切除术的未来在于一个精确的、多模式的框架,它集成了先进的成像、术中功能评估和患者特异性康复策略。虽然机器人手术已经为解剖保存建立了一个新的基准,但它有望改善肿瘤和生活质量。严格的验证和标准化的报告对于将这些创新从研究应用转化为常规实践至关重要。
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来源期刊
Current Urology Reports
Current Urology Reports UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
3.80%
发文量
39
期刊介绍: This journal intends to review the most important, recently published findings in the field of urology. By providing clear, insightful, balanced contributions by international experts, the journal elucidates current and emerging approaches to the care and prevention of urologic diseases and conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as benign prostatic hyperplasia, erectile dysfunction, female urology, and kidney disease. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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