One of the biggest concerns for men having their prostate removed to treat cancer is the loss of erections. Professor Prokar Dasgupta pioneered a nerve-sparing technique called SAFE, short for Saline-Assisted Fascial Exposure, for use during robotic prostatectomy. This article explains why the nerves are vulnerable, how SAFE works and what the published SAFE nerve-sparing evidence shows.
Why erections are at risk
The nerve bundles that supply the penis run along both sides of the prostate gland. Because they sit so close to it, they can easily be damaged during surgery. Sometimes surgeons need to remove one or both bundles to give the best chance of removing the cancer completely. Our guide to nerve-sparing techniques explains this anatomy in more detail.
Why recovery takes patience
Even when the nerves are spared, recovery takes time. Nerves heal much more slowly than most other tissues in the body, and they can be affected by stretching or handling during the operation. That is why many men notice gradual improvement over months rather than weeks, and why rehabilitation is often recommended. Patience during this period matters, because slow early progress does not mean function will not return. Many men continue to improve well into the second year after surgery. Our article on erectile function after surgery describes what to expect.
How SAFE works
During robotic surgery, the surgeon uses a tiny needle to inject saline into the layers between the nerve bundles and the prostate. The fluid opens up the natural plane between them, so the nerve bundles can be gently peeled away from the gland while minimising damage. Professor Dasgupta describes the technique as simple, elegant and effective.
Because it adds only a small step to the operation, SAFE does not significantly lengthen surgery. Our related article on the SAFE technique explains the method and who it may suit.
What the evidence shows
Results from a team in New York comparing SAFE with standard nerve-sparing found that men who had saline-assisted dissection of the nerve bundles had better erections at six weeks, and at three, six and twelve months after robotic radical prostatectomy. The findings were published in the British Journal of Urology International, which describes the technique and results in detail.
Men who have good erections before surgery have a higher chance of recovering them afterwards with SAFE. As with any surgical technique, results vary between individuals, depending on age, general health and how much of each nerve bundle can safely be preserved.
Who may benefit
SAFE is used where nerve-sparing is appropriate. If the cancer lies close to or involves the nerves on one side, removing more tissue there may still be necessary, because cancer control always comes first. Your surgeon will plan each side separately, using your MRI scan and biopsy results.
Men who are considering surgery and want to preserve sexual function should raise this at their consultation. Useful questions include whether nerve-sparing is likely to be possible on one or both sides, and what results the surgeon sees in men with a similar diagnosis.
Part of a wider approach
SAFE is one part of a broader effort to protect quality of life after prostate cancer surgery. Careful planning from scans, precise robotic technique and structured rehabilitation all contribute. Prostate Cancer UK offers independent information on sex and relationships after treatment, and our robotic prostatectomy page describes the operation as a whole.
Learning more
Professor Dasgupta's research into robotic surgery spans more than two decades, and SAFE is one of several refinements he has introduced to protect function after prostate cancer surgery.
To discuss whether your nerve bundles can be safely spared, please contact the clinic to arrange a consultation.