erection-surgical

In a person whose blood vessels to the penis are damaged due to major accident Penile Revascularization restores blood supply and the person is able to have erection.

Team lead my Mathew C. Raynor of the Department of Urology, Vanderbilt University Medical Center, Nashville, Tenessee, USA, used epigastric vessel for reanastomosis (joining of blood vessels) in penis. They used robot to get the epigastric artery. The entire procedure required 3 cm incision, which is better alternative to large midline incision. There work on five patients who had severe pelvic (hip bone) trauma following accident was published in the Journal of Sexual Medicine yesterday September 25, 2009. This article is quoted below verbatim.

From
Journal of Sexual Medicine
Early View (Articles online in advance of print)
Published Online: 25 Sep 2009

© 2009 International Society for Sexual Medicine

Robot-Assisted Vessel Harvesting for Penile Revascularization

Mathew C. Raynor, MD,* Rodney Davis, MD, † and Wayne J.G. Hellstrom, MD, FACS*
*Department of Urology, Tulane Health Sciences Center, New Orleans, Louisiana, USA; † Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Correspondence to Wayne J.G. Hellstrom, MS, FRCS, Chief, Section of Andrology, Tulane University Health Sciences Center, Department of Urology, 1430 Tulane Avenue, SL-42, New Orleans, LA 70112, USA. Tel: (504) 988-5372; Fax: 504-988-5059; E-mail: whellst@tulane.edu
Copyright © 2009 International Society for Sexual Medicine

KEYWORDS

Erectile Dysfunction • Trauma • Arteriography

ABSTRACT

Introduction. Ideal candidates for penile revascularization include young patients with documented vasculogenic erectile dysfunction usually resulting from pelvic trauma. Historically, large midline incisions were necessary to harvest the epigastric vessels for penile revascularization. We report our experience with robot-assisted epigastric vessel harvesting for use in penile revascularization procedures.

Aim.

To describe our technique and experience with robot-assisted vessel harvesting for use in penile revascularization.

Methods.

Five patients were selected for penile revascularization. Each patient suffered pelvic crush injuries resulting in post-traumatic erectile dysfunction. Each patient had no significant prior medical history and had normal erectile function prior to injury. Penile duplex Doppler ultrasound studies using vasoactive agents demonstrated decreased arterial inflow. Complementary pelvic angiography documented the corresponding arterial lesions. Each patient underwent attempted penile revascularization using a modified Virag-V technique.

The epigastric artery was harvested robotically and transposed through a 3 cm incision at the base of the penis. Microscopic revascularization was performed by anastamosing the epigastric artery to the deep dorsal vein. Distal dorsal vein ligation of the subcoronal plexus was performed to limit glans hyperemia.

Main Outcome Measures.

Description of a new method of vessel harvesting for penile revascularization.

Results.

Penile revascularization was successful in four out of five patients. One patient had complete thrombosis of the deep dorsal penile vein and underwent subsequent penile prosthesis implantation. Each patient undergoing successful revascularization was discharged home two days postoperatively and has reported resumption of sexual activity.

Conclusions.

The robot-assisted approach to epigastric vessel harvesting is an ideal minimally-invasive complement to penile revascularization. This procedure negates the need for a large midline incision and may shorten recovery time. Our described technique offers a novel option for the application of minimally-invasive technology, but longer-term follow-up is needed to further evaluate the success of penile revascularization. Raynor MC, Davis R, and Hellstrom WJG. Robot-assisted vessel harvesting for penile revascularization. J Sex Med **;**:**–**.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1743-6109.2009.01462.x About DOI