Comparative analysis of functional outcomes between two different techniques after 1088 Robotic-Assisted Radical Prostatectomies in a high-volume cancer center: A Clipless approach.

Robotic-Assisted Radical Prostatectomy (RARP) has largely replaced open-technique worldwide as the first surgical modality for prostate cancer. We aim to describe the experience of RARP at a high-volume single cancer center, proposing a modified technique of nerve-sparing prostatectomy and comparing functional outcomes throughout our experience.

We retrospectively reviewed 1088 patients divided into group 1 (operated from May 2013 to November 2014), submitted to the standard transperitoneal robotic technique and group 2 (operated from December 2014 to December 2017), submitted to extraperitoneal RARP with complete anterior peri-prostatic preservation technique and a clipless approach (no use of clips and cautious use of bipolar energy). We constructed a retrospective 1:2 matched-pair analysis considering age, body mass index, D'Amico risk classification, and American Society of Anesthesiologists classification as matching criteria. Univariate and multivariate Cox logistic regression analysis were used to identify predictors related to the recovery of continence and erectile function.

Groups were comparable by clinical and demographic variables. There was no significant difference in overall continence rate. Mean-time for continence recovery was 6.6 months in group 1 and 5.8 months in group 2. Erectile function recovery, with or without drugs, in 12 months was described in 53.5% in group 1 and 75% in group 2. Potency recovery was significantly earlier in group 2.

In our experience, extraperitoneal RARP with complete anterior peri-prostatic preservation and a clipless approach is a feasible and reproducible technique. It demonstrated improved erectile function recovery and similar continence results. Prospective multicenter studies are needed to validate these results.

Journal of endourology. 2019 Sep 21 [Epub ahead of print]

Gustavo Cardoso Guimarães, Renato Almeida Rosa Oliveira, Thiago Borges Marques Santana, Ricardo Lima Favaretto, Thiago Camelo Mourão, Mauricio Murce Rocha, Rodrigo Madeira Campos, Stenio DE Cassio Zequi

Beneficencia Portuguesa de Sao Paulo, 155099, Head of Surgical Oncology Department, Sao Paulo, São Paulo, Brazil., ACCamargo Cancer Center, 139300, Urology Department, Sao Paulo, São Paulo, Brazil; ., ACCamargo Cancer Center, 139300, Urology Department, Sao Paulo, São Paulo, Brazil; ., ACCamargo Cancer Center, 139300, Urology Department, Sao Paulo, São Paulo, Brazil; ., ACCamargo Cancer Center, 139300, Urology Division - Fundacao Antonio Prudente, Rua Prof. Antonio Prudente, 211, Sao Paulo, Sao Paulo, Brazil, 01509-900; ., ACCamargo Cancer Center, 139300, Urology Department, Sao Paulo, São Paulo, Brazil; ., ACCamargo Cancer Center, 139300, Urology Department, Sao Paulo, São Paulo, Brazil; ., ACCamargo Cancer Center, 139300, Head of Urology Department, Sao Paulo, São Paulo, Brazil; .

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