Secondary Logo

Journal Logo

Prostate Cancer: Localized: Surgical Therapy VI (MP64): Moderated Poster 64: Monday, September 13, 2021


Basourakos, Spyridon; Lewicki, Patrick; Ramaswamy, Ashwin; Dudley, Vanessa; Hu, Jim

doi: 10.1097/JU.0000000000002104.08
  • Free


Athermal dissection of the lateral prostatic pedicles with surgical clips during robot-assisted radical prostatectomy (RARP) has been the gold standard since thermal injury of the unmyelinated nerve fibers may result in worse sexual function. However, clip migration may also cause anastomotic strictures. In this study, we explored the use of bipolar cautery for clipless prostatic pedicle dissection (RARP-bi) and pelvic lymph node dissection (PLND) and compared oncological, functional and adverse events (AE) outcomes to the standard approach with clips (RARP-c).


We retrospectively identified patients who underwent RARP-bi and RARP-c between July 2018 and March 2020. RARP-bi involved bipolar ligation of the lateral prostatic pedicles, the vasa deferentia and during PLND. We prospectively collected and retrospectively analyzed demographic, clinicopathologic and functional data. Urinary and sexual function were assessed using the Expanded Prostate Cancer Index for Clinical Practice (EPIC-CP). Outcomes were compared using Wilcoxon rank-sum and Fisher’s exact test as appropriate. Multivariable regression modeling was used to examine independent associations between RARP-bi and RARP-c approaches for positive surgical margins (PSM), sexual and urinary function scores.


Table 1 demonstrates a summary of our results. A total of 144 (43%) and 194 (57%) men underwent RARP-bi and RARP-c, respectively. Overall, there were no differences in functional and oncological outcomes between the two approaches. On multivariable logistic regression analysis, the RARP-bi technique was not associated with PSM (Odds ratio [OR]=1.04,95% confidence interval [CI] 0.6-1.8; p=0.9), sexual function (OR=0.4, 95%CI 0.1-1.5; p=0.8) or urinary function (OR=0.5, 95%CI 0.2-1.4; p=0.2). The overall 30-day complication rates (12% vs. 16%, p=0.5) and bladder neck contracture rates (2.1% vs. 3.6%, p=0.5) were similar between the two groups. All complications were Clavien Dindo group I-II.


Despite the concerns for increased risk for neuropraxia secondary to the use of bipolar cautery for prostatic pedicle dissection, we demonstrate that this technique is oncologically and functionally non-inferior compared to the standard approach with surgical clips.


Source of Funding:

Jim C. Hu receives research support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. Jim C. Hu also receives salary support from NIH R01 CA241758 and PCORI CER-2019C1-15682. The remaining authors report no further disclosures related to this work.

© 2021 by American Urological Association Education and Research, Inc.