How real-time intraoperative margin analysis is redefining nerve-sparing
prostatectomy — and why it matters for your life after surgery.
RD Dr. Rohit Dadhwal
Consultant Urologist & Robotic Surgeon · Fortis Hospital, Mohali
Surgery for prostate cancer should not mean choosing between
cancer control and quality of life. With the NeuroSAFE
technique, you no longer have to make that choice.
When a man is diagnosed with prostate cancer and advised surgery, his
first question is rarely “Will I be cured?” — he already trusts the surgeon
with that. His real fear is: “What will I lose?” Will he lose his ability to have
an erection? His urinary control? A part of his identity?
These are not small concerns. They are life-defining. And for decades,
surgeons have faced a difficult trade-off: the more aggressively we cut to
ensure all cancer is removed, the more likely we damage the delicate
nerves responsible for erection and continence that wrap around the
prostate. The NeuroSAFE technique changes that equation fundamentally.
What Is the NeuroSAFE Technique?
NeuroSAFE — Neurovascular Structure-Adjacent Frozen-Section
Examination — is an advanced intraoperative technique performed during
Robotic Radical Prostatectomy (RARP). In simple terms: while the patient
is still on the operating table, the freshly excised prostate’s surface
margins (the sides lying closest to the nerve bundles) are immediately
sent to the pathology lab for a rapid frozen-section analysis.
Within minutes, the pathologist reports back: are cancer cells present at
the margins, or is the cut surface clear? This real-time feedback gives the
surgeon a critical decision point that standard surgery simply does not
have.
1
Prostate Removed Robotically
The Da Vinci Xi robotic system provides 3D magnification and
wristed precision for meticulous dissection around the
neurovascular bundles.
2
3
4
Margins Sent for Frozen Section — Instantly
The nerve-adjacent surface of the prostate is sliced and dispatched
to pathology while surgery continues. Results return in minutes, not
days.
Real-Time Decision by the Surgeon
If the margin is clear → the nerve bundle is confidently preserved. If
cancer is detected at the margin → additional tissue is excised
precisely at that location only, protecting the rest of the nerve.
Best of Both Worlds Achieved
Maximum cancer clearance AND maximum nerve preservation —
guided by evidence, not guesswork.
What the Evidence Says
The landmark NeuroSAFE PROOF trial, a Phase 3 randomized controlled
study published in The Lancet Oncology in 2025, is the most definitive
evidence yet. It enrolled 381 men with good preoperative erectile function
across multiple high-volume centres. The results were striking.
32%
2×
Men regained erections sufficient for
intercourse at 12 months with
NeuroSAFE
vs. 18% with standard RARP · Lancet Oncology
2025
76%
Bilateral nerve-sparing attempted
with NeuroSAFE
vs. 45% without · Lancet Oncology 2025
Higher likelihood of recovering sexual
potency compared to standard
surgery
NeuroSAFE PROOF Trial, UCL
≡
No increase in cancer recurrence
rates or positive surgical margins
Oncological safety confirmed · PROOF Trial
The IIEF-5 erectile function score at 12 months averaged 12.7 in the
NeuroSAFE group versus 9.7 in the standard group — a clinically
meaningful difference that translates directly into a man’s intimate life
and emotional wellbeing. Early urinary continence at 3 months was also
significantly better in the NeuroSAFE group.
Key Benefits for Patients
✦ Confident
nerve
preservation:
Surgeons can attempt nerve-sparing even in
borderline cases, knowing real-time pathology is
their safety net.
✦ Better erectile
function recovery:
✦ Earlier continence
return:
✦ No compromise
on cancer
control:
✦ Targeted
re
excision:
Doubled potency recovery rates versus
standard robotic prostatectomy.
Patients regain urinary control faster in the
postoperative period.
The technique does not increase the risk of
leaving cancer behind — oncological safety is fully
maintained.
If a margin is positive, only that precise area is excised —
not the entire nerve bundle — protecting maximum
function.
✦ Reduced
surgical
anxiety:
✦ Validated at
the highest
level:
Real-time feedback replaces the uncertainty of
“waiting for final pathology” to know if margins were
adequate.
Evidence from a Phase 3 RCT published in The
Lancet Oncology — the gold standard of surgical
evidence.
Why This Matters Beyond the Operating Room
Sexual function and urinary continence are not vanity concerns —
they are deeply tied to a man’s psychological health, relationship
quality, and overall recovery. Studies consistently show that men who
retain these functions post-prostatectomy report significantly higher
quality of life scores, lower rates of depression, and better cancer
survivorship experiences. NeuroSAFE is, at its core, a commitment to
the whole patient — not just the tumour.
Who Is a Good Candidate for NeuroSAFE?
IDEAL CANDIDATES
Men with localized or locally
advanced prostate cancer who
have good preoperative erectile
function and wish to preserve it
YOUNGER, ACTIVE MEN
Patients for whom quality of life
post-surgery is a high priority
alongside cure
INTERMEDIATE-RISK DISEASE
Cases where nerve-sparing is
desirable but oncological safety
is uncertain — NeuroSAFE
resolves this intraoperatively
REQUIRES EXPERT CENTRE
NeuroSAFE demands on-site
pathology infrastructure and a
high-volume robotic surgery
team — it cannot be offered
everywhere
The Only Surgeon in This Region
Performing NeuroSAFE-Guided RARP
★
NeuroSAFE is a highly specialized technique that requires not
only advanced robotic surgical expertise but also dedicated
intraoperative pathology infrastructure and a coordinated
operating team. It is currently available at only a handful of
centres across India — and in the entire Punjab-Chandigarh
Tricity region, I am the only urological surgeon offering this
technique as part of routine robotic prostatectomy practice.
◆ MCh
Urology
— All India Institute of Medical Sciences (AIIMS),
New Delhi
◆ Uro-Oncology
Fellowship
— Mayo Clinic, USA (one of the world’s
foremost cancer institutions)
◆ Consultant Urologist &
Robotic Surgeon
◆ Da Vinci Xi 4th
Generation System
◆ National
pioneer in
Rezūm Water
Vapor Therapy
— Fortis Institute of Robotic
Surgery, Mohali
— the most advanced robotic
surgical platform available
for BPH — high-volume
practitioner
◆ Specialist in Robotic Radical Prostatectomy, Partial & Radical
Nephrectomy, and Complex Reconstructive Urology
Punjab Leadership Awards 2026 — Most Iconic Healthcare
Leader · World Health & Wellness Congress, 10th Edition
The Bottom Line
Prostate cancer surgery has come a long way. From open radical
prostatectomy to laparoscopic, then robotic — each era brought better
precision, less blood loss, faster recovery. NeuroSAFE represents the next
leap: giving surgeons live, real-time pathological intelligence at the most
critical moment of the operation.
The data is unambiguous. Men operated with the NeuroSAFE technique
are twice as likely to regain sexual function. They recover continence
faster. And they do so without any compromise in cancer control. That is
not a trade-off — that is a transformation.
If you or a loved one is facing prostate cancer and considering surgery,
you deserve to know that this option exists — and that you do not have to
travel abroad to access it.
Ready to Discuss Your Options?
Book a consultation with Dr. Rohit Dadhwal at Fortis Hospital,
Mohali — and take the first step toward treatment that protects
both your cancer outcome and your quality of life.
Book a Consultation →
Dr. Rohit Dadhwal · MCh Urology (AIIMS) · Uro-Oncology Fellowship, Mayo Clinic USA · Fortis
Institute of Robotic Surgery, Mohali, Punjab, India
Medical content is for educational purposes. Individual outcomes vary. Please consult directly for
personalized advice.