One of the main challenges in prostate cancer surgery is removing the cancer completely while protecting the nerves that control erections and help with bladder control. Professor Prokar Dasgupta developed a technique called SAFE, which stands for Saline-Assisted Fascial Exposure, to help with this. This article explains what the SAFE technique for nerve-sparing involves, how it works and why it may benefit patients.
Why nerve-sparing matters
The prostate is closely surrounded by two thin bundles of nerves and blood vessels, known as the neurovascular bundles. These are essential for erections and also contribute to urinary control. During a radical prostatectomy, they can be stretched, bruised or damaged as the prostate is removed.
Nerve-sparing surgery aims to preserve these bundles wherever it is safe to do so. Our guide to nerve-sparing techniques explains the anatomy in more detail.
What the SAFE technique involves
During robotic surgery, the surgeon gently injects a small amount of sterile saline into the thin layer of tissue between the prostate and the nerve bundles. The fluid creates a natural plane of separation, lifting the nerves slightly away from the gland.
This makes the boundary between the prostate and the nerves easier to see. The surgeon can then separate them with less traction or pressure on the nerves themselves.
The intended benefits
SAFE is designed to:
- improve the view of the delicate nerve tissue
- reduce traction and pressure on the nerves during dissection
- lower the risk of accidental nerve injury
- support recovery of erectile function and continence after surgery
It adds a simple step to the operation without significantly increasing operating time or risk.
How it differs from standard nerve-sparing
Conventional nerve-sparing relies on careful dissection and the surgeon's experience in finding the right tissue plane. This works well in many cases, but it can be more challenging where the nerves are tightly attached to the prostate. In those situations, the saline separation used in SAFE can make the plane clearer and the dissection more controlled.
Research and experience
Early studies and ongoing clinical experience suggest that SAFE can improve functional outcomes without compromising cancer control. Professor Dasgupta continues to refine the technique and uses it within his robotic surgery practice. You can read more about his research on the achievements page, and our related article on the SAFE technique gives further background.
Independent information on the side effects of prostate surgery, and how they are managed, is available from Prostate Cancer UK.
Is SAFE suitable for me?
Not every patient can have full nerve-sparing. Whether SAFE is appropriate depends on:
- where the cancer sits and how aggressive it is
- age and function before surgery
- the anatomy of the prostate
If the cancer is close to or involves the nerves on one side, removing more tissue there may be necessary. Cancer control always comes first. Your surgeon will use your MRI scan and biopsy results to plan each side and will discuss whether SAFE nerve-sparing is likely to be possible in your case. NICE guidance on prostate cancer sets out how treatment decisions are made.
Recovery after nerve-sparing surgery
Even when the nerves are preserved, they need time to recover. Erections usually return gradually over many months, and a rehabilitation plan can help. Our article on erectile function after surgery explains what to expect.
An advance in patient-centred surgery
The SAFE technique reflects a wider aim in modern prostate surgery: to treat the cancer effectively while protecting the functions that matter for everyday life. It is one example of how small refinements in technique can make a difference to patients.
To discuss whether SAFE nerve-sparing may be possible for you, please contact the clinic to arrange a consultation with Professor Dasgupta.