Robot‐assisted radical perineal prostatectomy: a review of 95 cases

Abstract

Objectives To assess the early functional and oncological outcomes of a large series of patients who underwent robot‐assisted radical perineal prostatectomy (RPP). Materials and Methods We retrospectively analysed the patients who underwent robot‐assisted RPP for localized prostate cancer between November 2016 and September 2018. Patients who had locally advanced disease proven on biopsy or were suspected to have locally advanced disease on multiparametric magnetic resonance imaging and patients who had a contraindication for the exaggerated lithotomy position were not included in this study. Patient demographics, preoperative and postoperative variables, complications and follow‐up times were recorded. Results A total of 95 patients were included. Their mean ± sd age was 61.5 ± 6.5 years. The median (interquartile range [IQR]) preoperative prostate‐specific antigen level was 6.1 (3.7) ng/mL, the median (IQR) operating time was 140 (25) min, and the mean ± sd blood loss was 67.4 ± 17 mL. Pelvic lymph node dissection (PLND) was performed for 12 patients (12.6%). The median (IQR) hospital stay was 1 (1) days. Positive surgical margins were present in eight patients (8.4%). After catheter removal, the immediate continence rate was 41%. Continence rates were 78%, 87% and 91%, respectively, 3, 6 and 12 months after surgery. Potency rates were 49%, 69% and 77%, respectively, 3, 6 and 12 months after surgery for patients who had adequate potency preoperatively. The median (IQR) follow‐up time was 13 (3.1) months. Conclusion We conclude that robot‐assisted RPP is a reliable and effective surgical technique that can be employed in the treatment of localized prostate cancer regardless of prostate volume, especially in patients with a history of abdominal surgery. As an additional advantage, PLND can be performed through the same incision.

Xi Nerve-sparing Robotic Radical Perineal Prostatectomy: European Single-center Technique and Outcomes

“…In our series, in all but five cases (all patients with IIEF-5 <17), the nerve-sparing approach was accomplished. This demonstrates that one of the advantages of using the Xi system is to facilitate this step, allowing adherence to a key oncological principle, as also pointed out in the guidelines [11] .…”

“…Port placement represents a key point in performing a perineal approach with a multiport robotic platform, as also described by Tuğcu et al [11] . The da Vinci Xi system facilitates this approach by maximizing freedom of movement, minimizing instrument clashing, and providing good ergonomics during the critical steps of the procedure, compared with Si [20] , [21] , [22] .…”

“…Regarding oncological outcomes, nine (34.5%) patients reported PSMs in our cohort. In the largest cohort available to date, Tuğcu et al [11] analyzed the outcomes of 95 patients who underwent r-RPP between 2016 and 2018. The authors reported that only eight (8.4%) patients presented PSMs after the surgical procedure [11] .…”

“…In the largest cohort available to date, Tuğcu et al [11] analyzed the outcomes of 95 patients who underwent r-RPP between 2016 and 2018. The authors reported that only eight (8.4%) patients presented PSMs after the surgical procedure [11] . These results are dissimilar to other series looking at an open or minimally invasive approach [3] , [23] , [31] .…”

“…To date, few centers reported their early experience with robotic radical perineal prostatectomy (r-RPP), especially using the da Vinci Si platform [9] , [10] . More recently, the introduction of the da Vinci Xi surgical system further facilitated this surgical approach, making it more reproducible and safe [11] . Furthermore, no study evaluated the safety of r-RPP in agreement with the standardized methodology to report complications proposed by European Association of Urology guidelines [12] .…”