For many years, surgeons have been trying to use real-time transrectal ultrasonography to enhance intra-operative imaging of the neurovascular bundles. Manipulation of a rectal probe is cumbersome, however, when the da Vinci robot is used. Han and colleagues present an elegant approach demonstrating the use of a robotic arm to hold the ultrasound probe. In a small group of patients, the feasibility of this approach was tested. What remains to be seen is whether this will improve outcomes of erectile function. The theoretical basis for such an improvement is that the neurovascular bundles are 2 distinct structures, the vascular components of which can be identified with ultrasound, helping the surgeon to avoid damaging these structures. The concept that the neurovascular bundles are 2 distinct anatomic structures was based on limited cadaveric dissection, however. There is accumulating evidence that there is variability in nerve distribution and that, in many patients, the nerves responsible for erectile function are not found exclusively within this putative neurovascular bundle.
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