Use of intraoperative video documentation to improve sexual function afterradical retropubic prostatectomy

Objectives. To determine whether arbitrary minor variances in surgical tech nique can have a major impact on the recovery of sexual function after radi cal retropubic prostatectomy. Methods. The surgical procedures of 62 potent men were videotaped prospecti vely. Eighteen months after the study was initiated, the videotapes were re viewed and specific steps in the surgical procedure correlated with patient -reported potency rates, Results. Four steps were identified that appeared to correlate with the rec overy of sexual function: oversewing back-bleeders from the proximal dorsal vein on the anterior surface of the prostate, division of the striated sph incter when placing urethral sutures, division of the posterior striated sp hincter, and hemostasis at the end of the case. Conclusions. We believe that retrospective review of intraoperative videota pes has great promise. Because many surgeons use different techniques, it i s likely that each individual may be able to identify other important arbit rary variations that may improve their patients' outcomes. Similarly, for s urgeons with less than optimal outcomes, the review of early successful cas es may enable them to identify ways that modification of their surgical tec hnique can improve the outcome of future patients. To the best of our knowl edge, the use of retrospective review of intraoperative videotapes has not been commonly used in any other surgical field. (C) 2000, Elsevier Science Inc.