Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The use of robotic arms for instrument and camera manipulation has been proposed for more than a decade. The current study provides a direct comparison of robotic camera movement to the conventional human camera holding assistance in real operative room setting. OBJECTIVE • To assess, in a prospective randomized study, the efficiency of the FreeHand® (Prosurgics Ltd, Bracknell, UK) compared to manual camera control during the performance of endoscopic extraperitoneal radical prostatectomy (EERPE). PATIENTS AND METHODS • Three surgeons performed 50 EERPE for localized prostate cancer. In group A (n= 25), procedures were performed with manual control of the camera by the assistant, whereas group B (n= 25) patients were treated with the assistance of the FreeHand® robotic device. • The EERPE procedure was divided into several steps. • Total operation duration, time for each surgical step, number of camera movements, number of movement errors, number of times the lens was cleaned, blood loss and margin status were compared. RESULTS • No statistically significant difference was observed in terms of patient age, preoperative prostate‐specific antigen level, Gleason score, positive cores and prostate volume. • The average operation duration required for the performance of each step did not differ significantly between the two groups. • Significant differences in favour of the FreeHand® camera holder were observed in case of horizontal and zooming camera movement, camera cleaning and camera errors. • Vertical camera movements were performed significantly faster by the human assistant compared to the robotic camera holder. • The average total operation duration was similar for both groups. • Positive surgical margins were detected in one patient in each group (4% of the patients). CONCLUSIONS • A comparison of the FreeHand® robotic camera holder with human camera control during EERPE showed a similar time requirement for the performance of each step of the procedure. • The robotic system provided accurate and fast movements of the camera without compromising the outcome of the procedure.

Objective: The current study investigates the effect of bladder neck (BN) preservation on postoperative continence and positive surgical margins (+SMs). Patients and Methods: 150 patients (group 1) who underwent BN-sparing endoscopic extraperitoneal radical prostatectomy (EERPE) and 90 patients treated with EERPE and BN resection (group 2) were retrospectively evaluated. Results: Both groups were similar for age, prostate-specific antigen and prostate size. There was no significant difference in operative time, mean blood loss or transfusion rate. Mean catheterization time was similar. The overall +SM rates were very similar at 10.7% for group 1 and 10.0% for group 2 (group 1, pT2 = 5.1% and pT3 = 30.3%; group 2, pT2 = 2.9% and pT3 = 33.3%). One of 16 patients in group 1 and 1 of 9 in group 2 had a +SM at BN. Statistically significant differences in continence were observed 24 h after catheter removal and 3 months postoperatively between both groups. Conclusion: BN preservation proved to have an impact on postoperative early continence of patients undergoing EERPE. Continence of patients who underwent BN preservation was improved after catheter removal and at the 3-month follow-up in comparison to those without BN preservation, but +SMs were not affected by the BN-sparing surgery.

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