Transition from standard robotic prostatectomy to Retzius-sparing prostatectomy: feasibility and early outcomes

Elliott, Nicholas; Pahouja, Gaurav; Felice, Michael; Capoccia, Edward; Patel, Parth M.; Martinez, Enrique Blanco; Aiwerioghene, Eseosa; Gorbonos, Alex

doi:10.1007/s11701-023-01596-w

Cited by 3 publications

(2 citation statements)

References 17 publications

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“… 50 Elliot et al evaluated the results of a single experienced robotic surgeon who transitioned from standard RALP to RS-RARP. 51 A longer operating room time has been documented. Complication rates were similar.…”

Section: Methodsmentioning

confidence: 99%

“…Time to urinary continence and immediate continence rate were higher in the RS-RARP group. 51 RS-RARP can be safely adopted by experienced standard RARP surgeons without compromising early oncological outcomes and with the benefit of improved early continence recovery. Moreover, the RS approach can be considered feasible, safe and attractive for surgeons properly trained, even for those who are at the beginning of their robotic experience.…”

Section: Learning Curve In Rs-rarpmentioning

confidence: 99%

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Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

Ferretti,

Dell'Oglio,

Ciavarella

et al. 2023

RRU

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Robotic-assisted radical prostatectomy (RARP) is the gold standard for localized prostate cancer. Several RARP approaches were developed and described over the years, aimed at improving oncological and functional outcomes. In 2010, Galfano et al described a new RARP technique, known as Retzius-sparing RARP (RS-RARP), a posterior approach through the Douglas space that spares the anterior support structures involved with urinary continence and sexual potency. This approach has been used increasingly in many centers around the world comparing its results with those of the most used standard anterior approach. Several randomized controlled trials, systematic reviews and meta-analyses demonstrated an important advantage relative to standard anterior RARP in terms of early urinary continence recovery, with comparable perioperative and long-term oncological outcomes. Several surgeons are concerned regarding RS-RARP because it appears to increase the risk of positive surgical margins (PSMs). However, this statement is based on low-certainty evidence. Indeed, the available studies compared the results of surgeons who had an initial experience with posterior RARP with those who had a solid experience with anterior RARP. Recent evidence strongly suggests that RS-RARP is feasible and safe not only in low- and intermediate-risk prostate cancer patient but also in challenging scenario such as high-risk setting, salvage prostatectomy and after transurethral resection of the prostate.

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Section: Methodsmentioning

confidence: 99%

Section: Learning Curve In Rs-rarpmentioning

confidence: 99%

Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

Ferretti,

Dell'Oglio,

Ciavarella

et al. 2023

RRU

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Retzius sparing robot-assisted radical prostatectomy: optimizing functional results

Chierigo,

Caviglia,

Cellini

et al. 2024

World J Urol

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Robot-assisted radical prostatectomy in patients after endoscopic surgeries on the prostate

Guliev,

Ilyin,

Kharchenko

et al. 2024

Onkourologiâ

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Background. In literature, data on the results of robot-assisted radical prostatectomy (RARP) in patients after transurethral resection of the prostate (TURP) are contradictory.Aim. To evaluate surgical, functional, and oncological outcomes of RARP after TURP.Materials and methods. At the Urology Center of the Mariinsky Hospital (Saint Petersburg), RARP was performed on 410 patients. Among them, 28 (6.8 %) patients (1st group) previously underwent TURP due to infravesical obstruction. Among them, 18 (64.3 %) patients were diagnosed with prostate cancer after pathomorphological examination of the tissue resected during TURP, and on them RARP was performed on average 3.2 months later. In 10 (35.7 %) patients, prostate cancer was diagnosed during transrectal biopsy due to increased prostate-specific antigen level; on them RARP was performed on average 42.0 months after TURP. The following parameters were evaluated: operative time, time of bladder neck reconstruction and urethrovesical anastomosis formation, blood loss volume, tumor pathological stage, Gleason score, surgical margin status, rates of urine continence and preservation of erectile function.Results. Mean operative time was higher in the 1st group compared to the 2nd: 210 ± 36 min versus 180 ± 25 min (р <0.0001). In the 1st group compared to the 2nd, reconstruction of bladder neck was necessary more frequently (82.1 % versus 10.7 %; р <0.0001), urethrovesical anastomosis took longer time (32 ± 2.3 min versus 24.5 ± 3.1 min; р <0.0001), mean blood loss volume was higher (240 ± 39 mL versus 170 ± 32 mL; р <0.0001). Frequencies of positive surgical margin were 14.3 and 10.7 % respectively in the 1st and 2nd groups (р = 0.840). Frequencies of all complications were 28.6 and 21.4 %, respectively. Severe complications (≥IIIb grade per the Clavien classification) were observed in 2 (7.1 %) patients in both groups. Frequency of anastomosis stricture after surgery was significantly higher in the 1st group: in 2 (7.1 %) and 1 (3.6 %) case, respectively (р <0.05). In the 1st group, total urinary continence was achieved in 14 (50.0 %), 20 (71.5 %), 22 (78.5 %) and 25 (89.3 %) patients at early and 3-, 6and 12-month follow-up after RARP; in the 2nd group, it was achieved in 18 (64.3 %), 22 (78.6 %), 24 (85.7 %) and 26 (92.9 %) patients in the same follow-up periods. After 6 and 12 months, in the 1st group among 15 (53.6 %) patients with normal initial erectile function, satisfactory erectile function was preserved in 46.7 and 93.3 % of patients; in the 2nd group among 19 (67.8 %) patients, in 57.8 and 94.7 % patients, respectively.Conclusion. RARP after TURP is a relatively complicated surgical intervention with long operative time and high blood loss volume. However, functional and short-term oncological outcomes of RARP in these patients do not differ at 12 months.

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Transition from standard robotic prostatectomy to Retzius-sparing prostatectomy: feasibility and early outcomes

Cited by 3 publications

References 17 publications

Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

Retzius sparing robot-assisted radical prostatectomy: optimizing functional results

Robot-assisted radical prostatectomy in patients after endoscopic surgeries on the prostate

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