The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy

Abstract

Introduction: To assess the outcomes of Retzius sparing robotic-assisted radical prostatectomy (RS-RARP) in comparison with the conventional RARP. Materials and Methods: A retrospective analysis of 320 cases of RARP, performed from 2014 April to 2019 April, was performed. The predictor variables included age, body mass index, clinical stage, prostate-specific antigen, Gleason score category in biopsy, D'Amico risk category, presence of the median lobe, prior transurethral resection of the prostate, and the ability to perform the RS-RARP. The outcome variables included console time, blood loss, blood transfusion, nerve sparing, bladder neck sparing, positive surgical margins (PSM), number and the site of PSMs, extracapsular invasion, seminal vesicle involvement, complications, continence, erectile function, biochemical recurrence, and adjuvant treatment. Regression analysis was performed using the linear regression for the continuous variables and binary logistic regression for the categorical variables with two levels. Results: Three hundred and twenty patients underwent radical prostatectomy from 2014 April to 2019 April. We started the RS-RARP program in December 2016. Twenty-three patients who did not meet the inclusion criteria were excluded and a total of 297 patients were studied. Multivariate analysis demonstrated that RS-RARP was a strong positive independent predictor for continence recovery at 3 months, 6 months, and 12 months. RS-RARP was an independent predictor of reduced console time and increased probability of bladder neck sparing. RS-RARP was also independently associated with increased PSM in the posterolateral, anterolateral, and the apical regions. Conclusion: RS-RARP has better continence rates up to 12 months compared with the conventional approach, but is associated with increased PSM at certain locations.

Prostatectomía radical asistida por robot con abordaje Retzius-Sparing vs. Frankfurt modificado: comparación de resultados a 1 año de seguimiento

“…Kishore et al 12 realizaron un análisis retrospectivo para comparar la PRRA convencional vs. la PRRA-RS en 320 casos, evaluando entre sus variables la posiblidad de realizar el abordaje RS. Se excluyeron 23 pacientes, evaluando un total de 297.…”

“…Los márgenes quirúrgicos positivos después de PRRA-RS y PRRA convencional fueron del 29.9% y el 33.0%, respectivamente, con un incremento en la zona posterolateral, anterior y apical de la próstata, siendo más frecuente en pacientes con pT3. La recurrencia bioquímica posterior al año fue del 31% para PRRA convencional y del 21% para PRRA-RS; subsecuentemente, el 29.9% recibieron hormonoterapia y el 18.8% radioterapia en el grupo de PRRA convencional, mientras que en el de PRRA-RS el 26% recibieron hormonoterapia y el 11% radioterapia 12 . Karsiyakali et al 13 incluyeron 238 pacientes para comparar la PRRA convencional vs. la PRRA-RS.…”

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

“…Of note, 24 studies comparing RS-RARP to other approaches have been published up to April 15, 2023. Most reports aimed to demonstrate differences between RS-RARP and other approaches in terms of early and late urinary continence (Table 1) [5–8,9 ▪ ,10,11 ▪ ,12–16,17 ▪ ,18,19 ▪ ,20–22,23 ▪ ,24 ▪▪ ,25–28], but none focused on erectile function as primary endpoint. A minority of the studies reported data on sexual function, never finding significant differences among the RARP approaches.…”

Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer

“…Работа в операционном поле и визуальные преимущества РАРП изначально были восприняты с энтузиазмом, так как было много положительных отзывов от хирургов, выполняющих оперативные вмешательства на роботе Da Vinci. Различные исследования продемонстрировали раннее восстановление континенции (<90 дней) после РАРП при выполнении тщательного рассечения верхушки, передней и задней реконструкции и сохранении шейки мочевого пузыря [19]. Однако проспективное исследование, анализирующее 12-месячную континенцию во всех категориях риска, выявило аналогичные результаты между РАРП и открытой РПЭ (OR: 1.08; 95 % доверительный интервал ДИ 0,87-1,34) [1].…”