Potency is controlled via very fine and sensitive nerve fibers which, on their way from the brain to the penis, run very closely along the prostate. If this fine neurovascular structure can be spared in the operation, then, by and large, erectile function is maintained.
The nerve-sparing operation – whether with open surgery or in a robot-assisted da Vinci® procedure – is only possible for patients without additional risks if the tumor is located within the prostate capsule. If tumor cells have broken through the capsule into the area of the neurovascular bundles, the nerve tissue around the prostate must be removed unilaterally or bilaterally. At present, there is no pre-operative procedure which could provide us with the necessary information with an acceptable level of accuracy with regard to our standards concerning patient safety. It is by no means possible to detect with the naked eye the spread of tumors into the neurovascular bundles.
The Martini-Klinik has established a procedure for the examination of the complete contact surface of the removed prostate with the neurovascular bundle. This procedure provides vital help during the operation: the so-called intra-operative frozen section, the NeuroSAFE-technique. When the prostate is removed, the surgeon removes the side margins of the organ in the operating theatre. These are then immediately microscopically examined at the Department of Pathology at the University Clinic Hamburg-Eppendorf, which is specialized in prostate cancer. Some thirty minutes later, the pathologist informs the surgeon of the results in a telephone call. If the examined margins of the prostate are tumor-free, the neurovascular bundles can be spared. If cancer cells are found on the margins where the surgeon had performed the cut, then the affected parts of the neurovascular bundle must be removed during the operation as a measure which is conducive to tumor healing.
Advantages of the NeuroSAFE-Technique
No imaging method (including sonography, MRT, PET-CT) is more accurate than the microscopic examination of tissue to assess the spread of the tumor while granting the patient a maximum of safety. Thanks to the NeuroSAFE- Technique only nerve tissue which is actually affected by the tumor is removed. Healthy nerve tissue can be spared. This surgical technique which was developed in the Martini-Klinik makes it possible to determine during the operation whether the tumor has spread through the prostate capsule. The removal of the affected tissue significantly improves the chances of healing. This ensures maximum safety together with maximum nerve preservation. In the Martini-Klinik over 98% of all operations where the tumors are contained in the organ are carried out with the help of the nerve-sparing NeuroSAFE-technique – a number reached by hardly any other clinic worldwide.