Category: Robotic Surgery: New Techniques - Malignant
Introduction & Objective :
New techniques in robotic assisted radical prostatectomy (RARP) have evolved as urologists strive to improve patient outcomes. Achieving oncologic control with consistently perfect postoperative urinary and erectile function remains an elusive target. Building on the foundations of the retzius-sparing and lateral approaches to prostatectomy, with the goal of improving our functional outcomes, we developed the Functional Anatomy Sparing Technique for Prostatectomy (FAST-P). This series represents the learning curve and early experience.
The FAST-P was developed and performed by a single surgeon (KJ). Data was collected via retrospective chart review on consecutive patients who underwent the procedure from May through December of 2017. Patients were not offered this approach if there was a large anterior lesion on prostate MRI, due to preservation of the dorsal venous complex and anterior pubovesical structures. Demographic and operative details were collected, as were results from the validated Leakage Index (LI) and Sexual Health Inventory for Men (SHIM) questionnaires at 6 weeks follow up.
Eighty-five patients underwent FAST-P. Mean age was 62.3 and mean operative time was 166 minutes. Surgical pathology was Gleason 3+3 (9), 3+4 (60), 4+3 (14), or 4+5 (2). Stage was pT2 (75), pT3a (7), or pT3b (3). Complete continence data at 6-week follow up was available for 80/85 FAST-P patients. 66/80 (82.5%) patients were continent as measured by LI and pad usage.
This initial series demonstrates the FAST-P is feasible and reproducible. While many of these cases are early in the learning curve, the functional outcomes are promising, with high rates of early return to continence. Longer follow-up and additional study is warranted based on these encouraging results.