Techniques to Promote Nerve Regeneration After Robot-Assisted Radical Prostatectomy

Over the last two decades, knowledge of the anatomical structures surrounding the prostate has increased, along with the development of the surgical technique of radical prostatectomy. In this field, the robotic system has certainly played a crucial role, thanks to undoubted advantages such as image enlargement, three-dimensional vision, and improved surgeon dexterity due to miniaturized instruments. Over the last two decades, knowledge of the anatomical structures surrounding the prostate has increased along with the development of the surgical technique of radical prostatectomy. In this field, the robotic system has certainly played a crucial role, thanks to undoubted advantages such as image enlargement, three-dimensional vision, and better dexterity of the surgeon thanks to miniaturized instruments. Resection of both nerves eliminates spontaneous erections and suppresses the response to sildenafil. To facilitate nerve regeneration, the interposition of nerve grafts increases the chance of recovery of erectile function, which is probably related to the fact that the graft promotes axonal regeneration. The use of autologous nerve grafts minimizes the risk of rejection. Somatic nerves can be used to replace resected autonomic nerves and are more easily accessible in most cases: the sural nerve is the best example. New perspectives in the development of regeneration techniques focus on the use of substances such as growth factors or neurotrophic factors such as chitosan membrane.