Hypothermic Robotic ProstatectomyCooling to prevent surgical injuryCOMPLETELY NOVEL TECHNIQUE FOR REDUCING INFLAMMATION INJURY TO THE BLADDER SPHINCTERS AND NERVES FOR SEXUAL FUNCTION.BACKGROUND RESEARCH FROM UCI HAS LEAD TO A BETTER UNDERSTANDING OF MECHANISMS WHICH APPEAR TO INHIBIT RETURN OF SEXUAL FUNCTION. AWARDS & HONORS FOR THE UC IRVINEAge of Men vs % Pad Free at One Year1009086739610097 979287020406080100120All 40-49 50-59 60-69 70+Not Cooled CoolingP-value= .001Percentage of PrePotent Men Regaining Sexual function at 15 Months83660102030506070809040-7840Hypothermic Robotic Prostatectomy Cooling to prevent surgical injury COMPLETELY NOVEL TECHNIQUE FOR REDUCING INFLAMMATION INJURY TO THE BLADDER SPHINCTERS AND NERVES FOR SEXUAL FUNCTION. Technique ‘Hypothermic cooling and improvement in urinary continence.’ Prior work by Dr. Ahlering and his associates formed the basis for a better understanding into the mechanisms responsible for delaying return of urinary and sexual following surgery (see next section). If a surgeon performs ideally and avoids any injury to the sexual nerves and the sphincters responsible for urinary control, still most men take weeks to months to recover. There is much evidence to suggest that the normal trauma of surgery plays a major role in this problem. Drs. Ahlering and Finley have taken well established lessons from cardiac and neurosurgeons in using cooling to stop the inflammatory cascade common to all surgical procedures. Think of it as icing (or not) one’s ankle immediately upon severely spraining it. Actually, we can preemptively cool the region before the injury occurs. Hence, HYPOTHERMIC robotic prostatectomy. We devised an endorectal cooling balloon, pictured above, to locally cool the pelvic region to 60-68oF. The cooling balloon is placed and removed while the patients are asleep. It is safe, easy, painless and remarkably simple. Results on urinary continence demonstrated a reduction from 60 to 40 days to be free of urinary pads (Above Figure). These promising initial results validate the wisdom of preemptive cooling to satisfy the Hippocratic ‘Do no harm’. Another critical finding is that the overall percent of men becoming pad free has risen to approximately 96% (Above right bar graph). BACKGROUND RESEARCH FROM UCI HAS LEAD TO A BETTER UNDERSTANDING OF MECHANISMS WHICH APPEAR TO INHIBIT RETURN OF SEXUAL FUNCTION. Since 2002 when we started our program, we have published multiple scientific (9 peer-reviewed) papers laying the ground-work leading to hypothermia. Our first 3 publications dealt with the damage to nerves from thermal energy (heat) and how to avoid it. However, we learned that thermal energy did not kill the nerve but rather injured it. This injury is recoverable as long as the nerve sheath is still intact. However, even when we avoided thermal injury there was evidence of a stretch injury. With stretch injury some men recovered within 2-3 months (grade I), whereas others take 9-24 months (grade II) because the nerve has to grow from the prostate to the end of the penis. If the nerve was transected, the nerve function is lost because the nerve can’t re-grow (grade III). Another important finding is that the sexual nerves have a lot of redundancy. What this means, practically speaking, is that the sexual function which we normally think requires two nerves will recover with just one nerve 80% of the time (very similar to removing one kidney). Hence sparing every last little nerve is not as important for sexual function as is reducing inflammatory stretch injury. You might wonder how I thought of cooling… Well it came via ESPN. I was listening the night the Buffalo Bill football player fractured his cervical spine. Well needless to say as events unfolded I was glued to the updates. I thought if the cooling worked for Mr. Everett maybe it would help prevent the inflammatory injury of prostate surgery. We started right around the time of the Super Bowl…coincidentally with Everett’s walk at half-time… We now have potency data and it may change as we gain more experience. But as demonstrated above for normal men preoperatively potency increased 25% at 15 months from 66% to 83%. Not Cooled CoolingP-value= .05 References 1. Hypothermic nerve sparing radical prostatectomy: rationale, feasibility, and impact of early continence. Urology 73(4), 691-696, 2009. 2. Hypothermic Radical Prostatectomy: Impact on Continence J Endourology 23 (9): 1443-1450, 2009.Recent Findings in Prostate Cancer AWARDS & HONORS FOR THE UC IRVINE Internationally recognized, Dr. Thomas Ahlering has helped pioneer the use of the Da Vinci Robot for prostate cancer surgery in the United States, Europe, Asia and Australia. In fact, he performed the first robotic prostatectomies in Denmark, Canada and Australia. Now in its 9th year, the University of California, Irvine robotics program is one of the most respected with more than 900 robotic prostatectomies performed and more than 120 scientific publications and book chapters. We have published more than 15 abstracts and papers on the principles of nerve sparing technique. 9 papers listed below formed the background for cooling. Further, surgeons continue to come from around the United States, Canada, Europe and South America to visit and learn these techniques, via week long Mini-Residencies and Scientific programs sponsored the American Urological Association. Dr. Ahlering’s honors include American’s Best Doctors Designation, Who’s Who, Physician of Excellence, Orange Coast Magazine, and Intuitive Surgical's Pioneer of da Vinci Urology Surgery. He is the past President of the Western Section of the AUA. Potency References: (9) Feasibility Study for Laparoscopic Radical Prostatectomy Cautery Free Neurovascular Bundle Preservation Urology 65(5): 994-998, +video, May 2005 Early Potency with Cautery Free Neurovascular Bundle Preservation Study with Robotic Laparoscopic Radical Prostatectomy J. Endourology 19(6): 715-718, July/Aug 2005. Impact of Cautery versus Cautery Free Preservation of Neurovascular Bundles on Early Return of Potency J. Endourology 20(8): 586-589, Aug 2006. Spread of Thermal Energy and Heat Sinks: Implications for Nerve Sparing Robotic Prostatectomy. J. Endourology 21(10):1195-1198, Oct 2007. Overcoming Obstacles: Nerve Sparing issues in Robotic-assisted Laparascopic Prostatectomy. J. Endourology