Impact of Dehydrated Human Amniotic Membrane Allograft (AmnioFix) on continence and potency following robot-assisted radical prostatectomy

Introduction and Objectives: Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. This is the first reported study evaluating the early quality of life outcomes after placement of dHAM on the neurovascular bundle (NVB) during nerve-sparing robotassisted radical prostatectomy (RARP). We demonstrate our technique in this video. Methods: From March 2013 to July 2014, 58 preoperatively potent (Sexual Health Inventory for Men score >19) and continent patients underwent full nerve-sparing RARP, followed by intraoperative dHAM placement at our institution. In each patient, the dHAM was wrapped around the NVB following the RARP procedure. We performed propensity matching using our prospective database in matched nongrafted patients from the same time period. Pre-, peri-, and postoperative outcomes were analyzed between patient groups, including the time to return to continence and potency. Results: The use of dHAM was not associated with increased operative time, blood loss, or negative oncologic outcomes (p > 0.50). The mean follow-up was 4 months. Continence at 8 weeks returned in 79.3% of patients in the dHAM group and in 72.4% of patients in the group not receiving dHAM (p = 0.37). The mean time to continence and potency was significantly lower in the dHAM group compared to the matched non-dHAM group (1.21 vs 1.83 months, p = 0.03 and 1.34 vs 3.39 months, p = 0.007). Potency at 8 weeks returned in 63.8% (n = 39) of patients receiving dHAM and in 51.7% of patients in the non-dHAM group (p = 0.13). There were no adverse effects related to the graft. Conclusions: The use of dHAM allograft appears to hasten the early return of continence and potency in patients following RARP. Longer term follow up is required to assess the benefits over a broader period of time and to evaluate the potential negative events. A long-term randomized trial is warranted. Short-term results are encouraging for patient care

DEHYDRATED HUMAN AMNIOTIC MEMBRANE ALLOGRAFT NERVE WRAP AROUND THE PROSTATIC NEUROVASCULAR BUNDLE ACCELERATES EARLY RETURN TO CONTINENCE AND POTENCY FOLLOWING RADICAL ROBOT ASSISTED RADICAL PROSTATECTOMY : A PROPENSITY SCORE MATCHED ANALYSIS

INTRODUCTION AND OBJECTIVES: Allografts of dehydrated human amniotic membrane (dHAM) have cytokines and growth factors that have been shown to reduce the inflammatory response during tissue healing and promote nerve regeneration. We performed this study to evaluate the early quality of life outcomes after placement of dehydrated human amniotic membrane on the neurovascular bundle (NVB) during nerve sparing robot assisted laparoscopic prostatectomy (RALP) in a propensity score matched analysis. METHODS: From March 2013 to July 2014, 58 pre-operatively potent [Sexual Health Inventory for Men (SHIM) score >19] and continent patients underwent full nerve sparing RALP, followed by intraoperative dHAM placement at our institution. In each patient, dHAM was wrapped around the NVB following the RALP procedure. We performed propensity matching using our prospective database in matched, nongrafted patients from the same time period. Pre-, peri- and postoperative outcomes were analyzed between patient groups including time to return to continence and potency. RESULTS: The use of dHAM was not associated with increased operative time, blood loss or negative oncologic outcomes (p >0.50). The mean follow up was 4 months. Continence at 8 weeks returned in 79.3 % of patients the dHAM group and 72.4% of the group not receiving dHAM (p\ubc0.37). The mean time to continence and potency was significantly lower in dHAM group as compared to the matched non-dHAM group (1.21 months vs. 1.83 months, p\ubc0.03) and (1.34 months vs. 3.39 months, p\ubc0.007). Potency at 8 weeks returned in 63.8 % (n\ubc39) patients receiving dHAM patients and 51.7 % patients in the no-dHAM group (p\ubc0.13). There were no adverse effects related to the graft. CONCLUSIONS: The use of dehydrated human amniotic membrane allograft appears to hasten the early return of continence and potency in patients following RARP. Longer term follow up is required to assess the benefits over a broader period of time and to evaluate and potential negative events. A long term randomized trial is warranted. Short term results are very encouraging for patient care

Use of Intra-Operative Indocyanine Green and Firefly \uae Technology to Visualize the \u201cLandmark Artery\u201d for Nerve Sparing Robot Assisted Radical Prostatectomy

INTRODUCTION AND OBJECTIVES: The \u201cLandmark Artery\u201d has been shown to be a valuable landmark during nerve sparing radical prostatectomy in improving the quality of the neurovascular bundle (NVB) preservation. Sometimes this landmark can be challenging to find due to inexperience of the surgeon or anatomical challenges. Our goal was to evaluate an innovative intra-operative tool, Near-infrared (NIR) Firefly technology in conjunction with intravenous indocyanine green (ICG) to help identification of this \u201cLandmark Artery \u201dduring nerve sparing(NS) robot assisted radical prostatectomy(RARP). METHODS: Ten patients underwent nerve sparing RARP. Prior to clamping the pedicle or dissection of the NVB,0.75 cc of ICG was given. The Firefly technology was engaged on the robotic console and a period of 20-40 seconds was allowed for the ICG to enter the vascular system. The landmark artery was then observed bilaterally. After this time period we switched back to the non-firefly mode and proceeded with out normal NS operation. Data was collected regarding the % chance of being able to visualize this landmark in the 10 patients. RESULTS: In ten patients 20 NVB were examined with the ICG and Firefly technology. The landmark prostatic artery and its pathway could be identified in 17/20 NVB (85%). In the other 3 patients we were unable to visualize the artery as it was underneath some large veins. The artery was seen visually in these patients during the normal NS surgery. The use of ICG did not significantly increase operative time or result in any immediate or long term complications. CONCLUSIONS: The use of ICG and Firefly technology during NS radical prostatectomy has the potential to more accurately and more frequently identify the landmark prostatic artery that runs along the NVB. For experienced and novice surgeons the pathway of this artery is valuable for NS and can help improve nerve sparing qualit