Top

Published in:

04-05-2023 | Prostate Cancer | Research

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

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

Published in: Journal of Robotic Surgery | Issue 5/2023

Abstract

Background and Objective

Retzius-sparing robotic-assisted radical prostatectomy (rsRARP) has gained popularity due to superior early continence outcomes compared to standard robotic prostatectomy (sRARP). We evaluate the results of a single surgeon who transitioned from sRARP to rsRARP and compare oncologic and functional outcomes.

Methods

We retrospectively reviewed all prostatectomies performed by a single surgeon between June 2018 and October 2020. Perioperative, oncologic, and functional data were collected and analyzed. Patients who underwent sRARP were compared with those who underwent rsRARP.

Results

Both groups contained 37 consecutive patients each. Preoperative patient characteristics and biopsy results were similar between the two groups. Perioperative outcomes were significant for longer operative room time and higher proportion of T3 tumors in the rsRARP group. Thirty-day complication and readmission rates were similar between groups. There was no difference in early oncologic outcomes, including positive surgical margin rate, biochemical recurrence, and need for adjuvant or salvage treatments. The time to urinary continence and immediate continence rate was superior in the rsRARP group.

Conclusions

The Retzius-sparing approach can be safely adopted by surgeons experienced in sRARP without compromising early oncologic outcomes and with the benefit of improved early continence recovery.

Abbou CC, Hoznek A, Salomon L et al (2001) Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 165(6 Pt 1):1964–1966. https://doi.org/10.1097/00005392-200106000-00027CrossRefPubMed

Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58(3):457–461. https://doi.org/10.1016/j.eururo.2010.06.008CrossRefPubMed

Galfano A, Secco S, Bocciardi AM, Mottrie A (2020) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: an international survey on surgical details and worldwide diffusion. Eur Urol Focus 6(5):1021–2023. https://doi.org/10.1016/j.euf.2019.02.002CrossRefPubMed

Stanford JL, Feng Z, Hamilton AS et al (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 283(3):354–360. https://doi.org/10.1001/jama.283.3.354CrossRefPubMed

Guillonneau B, Vallancien G (2000) Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 163(6):1643–1649. https://doi.org/10.1016/s0022-5347(05)67512-xCrossRefPubMed

Nandipati KC, Raina R, Agarwal A et al (2007) Nerve-sparing surgery significantly affects long-term continence after radical prostatectomy. Urology 70(6):1127–1130. https://doi.org/10.1016/j.urology.2007.07.042CrossRefPubMed

Rocco F, Carmignani L, Acquati P et al (2006) Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol 175(6):2201–2206. https://doi.org/10.1016/S0022-5347(06)00262-XCrossRefPubMed

Nyarangi-Dix JN, Görtz M, Gradinarov G et al (2019) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer. BMC Urol 19(1):113. https://doi.org/10.1186/s12894-019-0550-9. (Published 2019 Nov 12)CrossRefPubMedPubMedCentral

Checcucci E, Veccia A, Fiori C et al (2020) Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes. BJU Int 125(1):8–16. https://doi.org/10.1111/bju.14887CrossRefPubMed

10.

Menon M, Dalela D, Jamil M et al (2018) Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol 199(5):1210–1217. https://doi.org/10.1016/j.juro.2017.11.115CrossRefPubMed

11.

Galfano A, Secco S, Bocciardi AM (2017) Will Retzius-sparing prostatectomy be the future of prostate cancer surgery? Eur Urol 72(5):686–688. https://doi.org/10.1016/j.eururo.2017.06.023CrossRefPubMed

12.

Jiang YL, Zheng GF, Jiang ZP et al (2020) Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis. BMC Urol 20(1):114. https://doi.org/10.1186/s12894-020-00685-4. (Published 2020 Aug 3)CrossRefPubMedPubMedCentral

13.

Lim SK, Kim KH, Shin TY et al (2014) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 114(2):236–244. https://doi.org/10.1111/bju.12705CrossRefPubMed

14.

Harty NJ, Kozinn SI, Canes D, Sorcini A, Moinzadeh A (2013) Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy. Int Braz J Urol 39(5):639–648. https://doi.org/10.1590/S1677-5538.IBJU.2013.05.05CrossRefPubMed

15.

Chang LW, Hung SC, Hu JC, Chiu KY (2018) Retzius-sparing robotic-assisted radical prostatectomy associated with less bladder neck descent and better early continence outcome. Anticancer Res 38(1):345–351. https://doi.org/10.21873/anticanres.12228CrossRefPubMed

16.

Olivero A, Galfano A, Piccinelli M et al (2021) Retzius-sparing robotic radical prostatectomy for surgeons in the learning curve: a propensity score-matching analysis. Eur Urol Focus 7(4):772–778. https://doi.org/10.1016/j.euf.2020.03.002CrossRefPubMed

Title: Transition from standard robotic prostatectomy to Retzius-sparing prostatectomy: feasibility and early outcomes
Authors: Nicholas Elliott
Gaurav Pahouja
Michael Felice
Edward Capoccia
Parth M. Patel
Enrique Blanco Martinez
Eseosa Aiwerioghene
Alex Gorbonos
Publication date: 04-05-2023
Publisher: Springer London
Keywords: Prostate Cancer
Prostate Cancer
Prostatectomy
Prostatectomy
Published in: Journal of Robotic Surgery / Issue 5/2023
Print ISSN: 1863-2483
Electronic ISSN: 1863-2491
DOI: https://doi.org/10.1007/s11701-023-01596-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background and Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2023

Improved accuracy of a novel fluoroscopy-based robotically assisted THA system compared to manual THA

Effects of remote ischemic preconditioning on renal protection in patients undergoing robot-assisted laparoscopic partial nephrectomy

Muscle fatigue and physical discomfort reported by surgeons performing robotic-assisted surgery: a multinational survey

Early perioperative outcomes of single-port compared to multi-port robot-assisted laparoscopic partial nephrectomy

Short learning curve in transition from laparoscopic to robotic-assisted rectal cancer surgery: a prospective study from a Finnish Tertiary Referral Centre

Systematic review: robot-assisted versus conventional laparoscopic multiport cholecystectomy