Robotic radical perineal prostatectomy: tradition and evolution in the robotic era

Abstract

Purpose of review To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms. Recent finding The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients’ morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer. Summary Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.

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

“…Our analysis relies on a prospectively maintained dataset that includes a granular description of the study population and its outcomes. Indeed, despite the diffusion of robotic surgery, the literature lacks surgical and postoperative details on Xi r-RPP [3] .…”

“…Overall, nine (34.5%) patients showed a past surgical history. One of the benefits of r-RPP is allowing an optimal surgical option in patients with a previous history of surgical procedure and/or obesity, and cardiac and pulmonary comorbidities, which represent a technical challenge during standard RARP [3] . Moreover, the perineal access minimizes the risks of accidental visceral or major vessel injuries, as well as the no steep Trendelenburg position limits the risk of anesthetic complications [3] .…”

“…Historically, perineal RP has been described as the first surgical approach for the complete removal of the prostatic gland [2] . Nevertheless, retropubic RP by Walsh is considered the most common surgical treatment for localized PCa to date [3] . This surgical approach overcame intrinsic technical limitations of the perineal RP, offering more familiar landmarks [3] .…”

“…Nevertheless, retropubic RP by Walsh is considered the most common surgical treatment for localized PCa to date [3] . This surgical approach overcame intrinsic technical limitations of the perineal RP, offering more familiar landmarks [3] .…”

“…RARP is frequently performed transperitoneally for the large working space and familiar anatomy [5] , [6] . Overall, the robotic platform provided some technical advantages as seven degrees of freedom, tremor filtration, a three-dimensional magnified view, and improved ergonomics that facilitate performing complex surgical steps, allowing to resume alternative approaches such as the perineal RP following the principles described by Young [2] , [3] , [7] , [8] .…”