Introduction: Regardless of an increasing anatomical knowledge und improved surgical techniques, postoperative erectile dysfunction remains to be one of the major threats for patients undergoing radical prostatectomy for prostate cancer. As a guidance for axonal regeneration, spider silk interposition has provided promising results in peripheral nerve reconstruction. This analysis investigates the safety and feasibility of the use of spider silk conduits in robotic radical prostatectomy.
Methods: Robotic radical prostatectomy with spider silk nerve reconstruction was performed in six patients with intermediate or high-risk prostate cancer. The major-ampullate-dragline from Nephila edulis was harvested and sterilized preoperatively. The saphenous vein was used for the construction of the spider silk conduit. After removal of the prostate with either uni- or bilateral nerve-sparing, the spider silk conduit was placed on the site of the neurovascular bundles. Data analysis included inflammatory markers and patient reported outcomes with standardized questionnaires.
Results: The median preoperative IIEF-5 (International Index of Erectile Function) score was 22. Median operative time was 258 minutes. In 50% of the cases, only a unilateral nerve-sparing was performed while bilateral nerve-sparing could be performed in three patients. Placement of the spider silk conduit was uneventful, contact of the spider silk with the surrounding tissue was sufficient for a stable connection with the proximal and distal ends of the dissected bundles; there were no intraoperative complications.
White blood cell count and C-reactive protein levels peaked until postoperative day 1 but stabilized until discharge without any need for further antibiotic treatment throughout the hospital stay. One patient was readmitted on postoperative day 12 for intravenous antibiotic therapy of a urinary tract infection. In the first follow-up after a median of 12 weeks three patients reported about erections sufficient for penetration.
Conclusions: In this analysis of the first robotic radical prostatectomies with spider silk nerve reconstruction, we could demonstrate a simple intraoperative handling without major intra- or postoperative complications. Early potency results are encouraging; however, long-term follow-up is needed to identify further improvement due to the spider silk directed axonal elongation and nerve regeneration.
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