Since a comprehensive knowledge of pelvic anatomy and the prostatic surrounding tissues, many technical improvements were allowed to perform a safer radical prostatectomy with better visualization and preservation of the cavernous nerves. Walsh et al. was a pioneer in the development of an innovative retropubic radical prostatectomy in the 1980s. In the recent years, the widespread use of robotic platform as the gold-standard to perform a radical prostatectomy allowed a large number of urologic surgeons to offer good oncological and functional outcomes. Beyond this point, robotic surgeries have elevated costs related to their implementation, particularly in developing countries. It is highly recommended that the surgical teams involved with a robotic surgery program are motivated to optimize costs and to improve their results.
We reported results of a Robotic-Assisted Radical Prostatectomy (RARP) series performed in patients with localized prostate cancer in a high-volume cancer center and proposed a technical modification, in order to reduce costs and to improve functional outcomes. Two different techniques were compared. In the first group, patients underwent transperitoneal RARP were included and they were compared with patients in the second group, who underwent extraperitoneal RARP with anterior peri-prostatic preservation and no use of surgical clips, but cautious use of bipolar energy.
A detailed step-by-step description of this adopted technique was reported in the article. An unedited video can be watched below.
Results showed that this described technique is feasible and it was related to better erectile function recovery at 12 months (75% vs. 53%). The recovery of continence was similar in both groups at 12 months. In the same way, surgical complications were reported similarly in both groups, particularly non-severe complications (Clavien I or II). We reported 8.8% of non-severe complications rate in group 1 and about 9.0% in the second group. We did not report a higher rate of symptomatic lymphocele and just five cases of hematoma into the prostatic surgical bed.
Written by: Thiago C. Mourão, MD and Gustavo C. Guimarães, MD, MsC, PhD, IUCR - Instituto de Urologia, Oncologia e Cirurgia Robótica, São Paulo, Brazil
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