機器人輔助根治性攝護腺切除術中鹽水輔助筋膜顯露法之初步臨床經驗與早期分析

黃君平、陳浩恩¹、曹智惟、陳進利

國防醫學大學三軍總醫院外科部泌尿外科；¹國軍臺中總醫院外科部

Initial Clinical Evaluation of Saline-Assisted Fascial Exposure (SAFE) During Robot-Assisted Radical Prostatectomy

Chun-Ping Huang, Hao-En Chen¹, Chih-Wei Tsao, Chin-Li Chen

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University; Department of Surgery, Taichung Armed Forces General Hospital¹

Introduction: Erectile dysfunction (ED) and urinary incontinence remain common functional complications after robot-assisted radical prostatectomy (RARP). Techniques that improve visualization and preservation of the neurovascular bundle (NVB) are critical for better postoperative outcomes. The Saline-Assisted Fascial Exposure (SAFE) technique is a modification of hydrodissection designed to enhance identification of fascial planes, reduce traction injury, and facilitate precise nerve-sparing dissection. We report our early clinical experience using SAFE during RARP.

Case Presentation: A 68-year-old man with hypertension and hyperlipidemia was diagnosed with clinically localized prostate adenocarcinoma (cT2a, PSA 5.152 ng/mL, Gleason score 3+4=7). Preoperative multiparametric MRI showed no evidence of extracapsular extension. He had normal erectile function and no urinary incontinence prior to surgery.

The patient underwent RARP with planned bilateral nerve preservation. During the procedure, the SAFE technique was used. A 22-gauge endoscopic injection needle was introduced through an assistant port under robotic guidance. Sterile normal saline was injected into the lateral prostatic fascia along the intended nerve-sparing plane. This created temporary separation between the prostatic capsule and surrounding fascia, improving visualization of the NVB. Sharp dissection was then performed along this plane with minimal electrocautery. Saline was injected incrementally under direct vision to avoid capsular injury or overdistension.

The surgery was completed without intraoperative complications. Estimated blood loss was 150 mL, and the patient was discharged on postoperative day 8. Final pathology showed prostate adenocarcinoma, Gleason score 4+3=7, stage pT2N0, with a focal positive surgical margin at the apex.

Outcomes: At 3-month follow-up, the patient achieved social continence (0–1 safety pad per day). There was no biochemical recurrence. Erectile function recovered without pharmacologic support, with a SHIM (IIEF-5) score of 23. No adverse events related to the SAFE technique were observed.

Conclusions: The SAFE technique was safely implemented during RARP and provided good visualization of fascial planes for nerve preservation. Early recovery of continence and erectile function was observed in this case. SAFE appears to be a feasible adjunct to RARP, although larger studies are needed to confirm its long-term functional and oncologic outcomes.