New Technology: Laparoscopy & Robotics
Moderated Poster Session
Introduction & Objective : To introduce the technique and report our initial experience of Retzius-sparing robotic assisted radical prostatectomy (RARP) and compare perioperative outcomes with the standard veil of Aphrodite technique (Veil technique).
Methods : 19 Retzius-sparing RARP and 20 Veil nerve sparing RARP with posterior reconstruction for T1c to T2c prostate cancer performed by a single surgical team between 2015 January and 2016 December were retrospectively reviewed. Preoperative data of patients in Retzius-sparing group [patient age (66.3±5.9) years, BMI (25.5±3.1) kg/m2, tPSA (16.4±5.0) ng/ml, biopsy Gleason score 6(5~7), prostate volume (32.7±7.4) ml and IIEF-5 score 14(5~18)] and Veil group[ patient age (64.6±7.3) years, BMI (25.5±2.0) kg/m2, tPSA (18.5±11.0) ng/ml, biopsy Gleason score 7(5~8), prostate volume (31.4±10.8)ml and IIEF-5 score 15(6~19)]. No significant difference was found between the two group in the above parameters (all P>0.05). All patients were continent preoperatively. Retzius-sparing RARP and Veil nerve sparing RARP were performed via transperitoneal RARP. Perioperative data of the two groups were statistically analyzed.
Results : All 39 cases were successfully performed robotically without conversion, transfusion or other major intraoperative and postoperative complications. Postoperative pathology confirmed5 pT2a cases, 8 pT2b cases and 6 pT2c cases in Retzius-sparing group and 7 pT2a cases, 5 pT2b cases and 8 pT2c cases in Veil group (all P>0.05). For Retzius group, operative time was (106.5±26.4) min and estimated blood loss was (48.9±20.2) ml, for Veil group, operative time was (93.2±20.8) min and estimated blood loss was (42.5±16.8） ml. No significant difference was found in the above parameters (all P>0.05). Urethral catheter was removed at postoperative 7-day (Retzius-sparing group) and 21-day (Veil group), respectively. 18 patients in Retzius-sparing group achieved urinary continence (0 pads) immediately after the removal of urinary catheter, while 1 patient returned to full continence in 2 weeks postoperatively. Patients in Veil group returned to continence (6.8±3.6) weeks postoperatively (PP>0.05).
Retzius-sparing RARP and the Veil nerve sparing RARP were both effective for the surgical treatment of localized prostate cancer. Our data revealed no statistical difference in perioperative outcomes between the two approaches, however, the Retzius-sparing technique seemed to yield a better outcome regarding early return to urinary continence postoperatively.
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