A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery

Galfano, Antonio; Ascione, A.; Grimaldi, Salvatore; Petralia, Giovanni; Strada, E.; Bocciardi, Aldo Massimo

doi:10.1016/j.eururo.2010.06.008

Cited by 247 publications

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“…These include the running Van-Velthoven anastomosis, posterior reconstruction or 'Rocco stitch' [1], and cold ligation of the Santorini plexus/dorsal vein to maximise urethral length. In 2010, Bocciardi's team in Milan proposed a novel posterior or 'Retzius-sparing' RARP (RS-RARP), mirroring the classic open perineal approach [2]. This allows avoidance of supporting structures, such as the puboprostatic ligaments, endopelvic fascia, and Santorini plexus, preserving the normal anatomy as much as possible and limiting damage that may contribute to improved postoperative continence and erectile function.…”

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confidence: 99%

“…The authors reviewed three studies from three different groups, including a study by our group [2][3][4], and raised three specific concerns: the oncological efficacy of the procedure; the long learning curve; and the generalizability of the technique to challenging surgical scenarios. We offer a few clarifications and comments.…”

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confidence: 99%

“…The first study on Retzius-sparing robot-assisted radical prostatectomy came from the Bocciardi group [2]. This was a prospective, single-arm study of 200 patients.…”

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Retzius‐sparing robot‐assisted radical prostatectomy (RS‐RARP) vs standard RARP: it's time for critical appraisal

et al. 2018

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Since robot-assisted radical prostatectomy (RARP) started to be regularly performed in 2001, the procedure has typically followed the original retropubic approach, with incremental technical improvements in an attempt to improve outcomes. These include the running Van-Velthoven anastomosis, posterior reconstruction or 'Rocco stitch' [1], and cold ligation of the Santorini plexus/dorsal vein to maximise urethral length. In 2010, Bocciardi's team in Milan proposed a novel posterior or 'Retzius-sparing' RARP (RS-RARP), mirroring the classic open perineal approach [2]. This allows avoidance of supporting structures, such as the puboprostatic ligaments, endopelvic fascia, and Santorini plexus, preserving the normal anatomy as much as possible and limiting damage that may contribute to improved postoperative continence and erectile function. There has been much heralding of the excellent functional outcomes in both the medical and the lay press, but as yet no focus or real mention of any potential downsides of this new technique.The RS-RARP approach demands staying very close to the prostate throughout its mobilisation by hugging the capsule, bladder neck sparing, and performing nerve sparing with dissection in an intra-or interfascial plane. The key attraction of this technique is proposed to be an earlier return to continence, with encouraging early results from Bocciardi's team. In their first 200 patients, performed by a single experienced surgeon, they found 90% of patients to be continent at 1 week after surgery, irrespective of learning curve [3]. These results were further supported by Rha's Korean group, who published a 50 patient-matched comparison study and found that 70% of patients in their RS-RARP group were completely dry at 1 month (70% vs 50% in the standard RARP group, P = 0.039) [4]. Neither of these studies used randomisation or blinding, and outcomes were reported subjectively. A subsequent randomised controlled trial (RCT) by Menon's group, at the Vattikuti Institute, allocated 60 patients to each arm to undergo either standard RARP or RS-RARP [5]. In a group of patients with low-and intermediate-risk localised prostate cancer (International Society of Urological Pathology [ISUP] grades 1-3), they found that 71% of patients were continent (0/1 pad/day) at 1 week after surgery vs 48% in the standard RARP group (P = 0.01). This rapid early return to continence was supported across multiple assessments: pad weight, time to continence, and the proportion of patients with no leakage at 1 month From the published results available, including this Level 1 evidence, there seems little doubt that 1 week after a RS-RARP men are more likely to be continent compared to standard RARP (Table 1) . [3][4][5]. However, this begs the question, is this an important outcome in a cancer operation? The median time to achieve continence was reduced by 6 days (RS-RARP 2 vs 8 days standard RARP), and from a patient-reported outcome measures perspective (IPSS qualityof-life score), a statistically significant difference w...

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Retzius‐sparing robot‐assisted radical prostatectomy (RS‐RARP) vs standard RARP: it's time for critical appraisal

et al. 2018

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“…In 2010, Galfano et al first described a novel technique of avoidance of all the anatomical structures related to continence and going directly through the Douglas space, the so-called Retzius-sparing prostatectomy (6). After opening Denonvilliers' fascia, the prostate gland would be posteriorly removed in a completely intrafascial plane without damage to the Santorini plexus, puboprostatic ligament, arcus tendineus and the levator ani muscle (6).…”

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Retzius-sparing Robotic-assisted Radical Prostatectomy Associated with Less Bladder Neck Descent and Better Early Continence Outcome

Chang

Hung

et al. 2018

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“…Além disso, a preservação da fáscia anterior com seus nervos pode melhorar a recuperação precoce da continência urinária e da potência sexual (Galfano et al, 2010;Walz et al, 2010).…”

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Avaliação prospectiva de curva de aprendizado da prostatectomia radical laparoscópica assistida por robótica

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, por me orientar neste trabalho e em tantos outros; pela sua grande contribuição para a minha formação, mas, em especial, pela sua amizade, respeito, sinceridade e dedicação, preenchendo a minha vida de momentos gratificantes e felizes. Muito obrigado! Ao Prof. Dr. Miguel Srougi, que me acolheu em seu Serviço de fellow e, posteriormente, me proporcionou a realização dessa tese. O convívio contigo transforma-nos em pessoas melhores; a vossa liderança e o incentivo à titulação é um estímulo para as novas gerações.Ao Prof. Dr. Alberto Azoubel Antunes, chefe da pós-graduação, pesquisador dos melhores, grande incentivador e amigo, contribuindo em todas as etapas deste projeto.Aos colegas urologistas que participaram das cirurgias analisadas nesta tese: Drs. Adriano Nesrallah, Alberto Antunes, José Arnaldo, Karlo Biolo, José Pontes, Luiz Carlos, Marco Nunes e Marcos Freire; a ajuda de todos foi essencial para a realização deste projeto.Aos Drs. Osmar, Ana Maria e Denise, pela presença constante durante todas as cirurgias; a presença de vocês me trazia felicidade.Aos membros da Banca de Qualificação, Prof. Dr. Alberto A. Antunes, Dr. José Pontes Júnior, e, especialmente, ao Prof. Dr. Marcelo Zerati, pelos comentários e correções que muito contribuíram para a conclusão desta tese.À Dra. Sabrina Thalita dos Reis e à enfermeira Mary Ellen Salles, responsáveis pelo auxílio nas tarefas burocráticas e atualização dos bancos de dados. Obrigado pelo imenso apoio na realização desta tese.Aos colegas da pós-graduação pelo excelente convívio, em especial, ao Dr. Daniel Kanda Abe, pela inestimável ajuda na obtenção de artigos científicos e pelas valiosas trocas de informações.À Elisa de Arruda Cruz, secretária da pós-graduação, pelo inestimável auxílio nas tarefas burocráticas.A todos os colaboradores da Divisão de Clínica Urológica, aqui representados pela Iones, Beth e Joselito, pela cordialidade e atenção com a qual fui recebido.À Rita de Cássia Ortega Borges, pelas valiosas informações técnicas e ajuda na formatação das referências.Ao Prof. Dr. Quintiliano Siqueira Schroden Nomelini pela brilhante análise estatística. À Márcia Andréia Ferreira Santos de Souza, pela revisão ortográfica e formatação primorosas. A todos os funcionários do Hospital Alemão Oswaldo Cruz e doInstituto da Próstata e, em especial, à enfermeira Ellen e aos auxiliares Rogério e Sandra, que participaram das cirurgias e dos atendimentos dos pacientes do estudo.A todos os pacientes que concordaram em participar do estudo e que contribuem com a ciência. Às minhas secretárias, Adelma, Angela, Fernanda, Izaltina, Janaína, Juliana, Lenice, Letícia, Luciane, Valdirene e Vanusa por tornarem minha vida organizada e me proporcionarem um ambiente de trabalho agradável.À minha família, esposa, filho, pais, irmãos, minhas cunhadas Fernanda e Layanne e meus sobrinhos Gabriel e Matheus que trazem a alegria ao convívio familiar.Aos meus avós paternos e maternos e, especialmente, à vovó Élvia, que sempre me apoiou e estará eternamente ao meu lado em todos os momentos da ...

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A New Anatomic Approach for Robot-Assisted Laparoscopic Prostatectomy: A Feasibility Study for Completely Intrafascial Surgery

Cited by 247 publications

References 9 publications

Retzius‐sparing robot‐assisted radical prostatectomy (RS‐RARP) vs standard RARP: it's time for critical appraisal

Retzius‐sparing robot‐assisted radical prostatectomy (RS‐RARP) vs standard RARP: it's time for critical appraisal

Retzius-sparing Robotic-assisted Radical Prostatectomy Associated with Less Bladder Neck Descent and Better Early Continence Outcome

Avaliação prospectiva de curva de aprendizado da prostatectomia radical laparoscópica assistida por robótica

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