Selected challenges to the Nerve-Sparing Radical Prostatectomy:

In the radical prostatectomy procedure, surgical objectives include removing the cancer, preserving continence, preserving erectile function, minimizing blood loss and minimizing surgery time.  The following section describes how the CaverMap™ Surgical Aid aids the surgeon to overcome the challenges to meeting one of the objectives above -- preserving cavernous nerve(s) associated with erectile function.

Figure 1. Photograph of pelvic cavity
Photo Source: http://www.surg.med.umich.edu/urology.poster.5.html

In the radical prostatectomy procedure, there are many barriers to identifying and mapping the location of the cavernous nerve(s).  The photograph of the pelvic cavity shows one view of the prostate and surrounding tissue that a surgeon may encounter.   It can be difficult to be completely confident of the location of the cavernous nerve(s).  Surgeons often look for the neurovascular bundle and assume that the cavernous nerve(s) are located in this structure.  It can be difficult to see this structure because the neurovascular bundle may be obscured by other tissue, blood or poor lighting.  Once the neurovascular bundle is identified, it may be difficult to map the course of the bundle as it goes from the apex to base of the prostate.  In addition, there are no commercially available tools to help the surgeon determine that the cavernous nerve filaments are all contained in the bundle, or that they are functional.

The CaverMap™ Surgical Aid is designed to assist surgeons identify and map the cavernous nerve(s), ultimately leading to preservation of erectile function.  The following information provides details on how the system can complement the surgeon's surgical technique.

Figure 2. Case study - cross section

This depiction of a cross section of the prostate illustrates how the CaverMap™ Surgical Aid was used by one surgeon to modify where he dissected during surgery.   The drawing on the left (A) shows how the surgeon would normally visualize or estimate the location of the nerve to be near the 5 and 7 o'clock positions on the prostate.  He would normally remove the tissue above the expected nerve location.

In the drawing on the right (B), using the CaverMap™ Surgical Aid, he discovered that the nerve was close to the 3:30 and 8:30 positions.  This discovery caused the surgeon to change his dissection and consequently preserve the nerve as measured by a stimulation at the end of the surgery.

Figure 3- Case Study - "Top view"

Another surgeon's depiction is shown in this top view image.  On the left, and without any tools, the surgeon would have dissected along a path around the prostate that would have cut and removed a section of the cavernous nerve.  With the CaverMap™ Surgical Aid, the surgeon mapped the nerve and changed his dissection to ultimately preserve the function of the nerve, as measured by stimulation at the end of the surgery.

Summary

The CaverMap™ Surgical Aid system may add value to the radical prostatectomy procedure by improving clinical outcomes, specifically reducing the rate of erectile dysfunction associated with the procedure.  This would lead to improving clinical outcomes, quality of life, and lower total healthcare costs.

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Cavermap^® Surgial Aid, Symmetra™ I-125, Introl^® and PelvicFlex™,   are trademarks of Blue Torch Corporation.

Surgical Slides:

CaverMap™ Surgical Aid

CaverMap™ Control Unit

CaverMap Unit hooked up

Tumescence Sensor

Dr. Scardino surgery

Dr. Scardino surgery

Stimulator