Laparoscopic Retzius-Sparing Radical Prostatectomy: Single Surgeon Experiences

Abstract

Purpose:

Robot-assisted radical prostatectomy (RaRP) is viewed as the main surgical option in patients with localized prostate cancer. Robot-assisted Retzius-sparing radical prostatectomy (Retzius-sparing RaRP) is also in development to achieve the trifecta (cancer free, continence, and potency). We modified the methodology of laparoscopic radical prostatectomy (LRP) based on the inspiration of Retzius-sparing approach.

Materials and Methods:

From May 2015 to March 2016, a total of nine patients underwent Retzius-sparing LRP. General characters of patients, perioperative parameters, and functional and oncologic data were collected. Patient position and trocar placement are similar to our anterior approach LRP and modified from Galfano et al. ¹ The steps of whole procedure were very similar to the method that Lim et al. ² had published to describe the process of Retzius-sparing RaRP. Cystograms were routinely performed on postoperative day 3 and the Foley catheter would be removed on the next day if no leakage. Continence was defined as no need for pad in daily life according by patients' statement.

Result:

The average operative time was 213.33 ± 43.3 minutes, whereas the average anastomosis time was 58.33 ± 15.21 minutes. The median amount of blood loss was 100 mL (IQR 100–200). Only one patient received bilateral neurovascular bundle (NVB) preservation, whereas four patients received unilateral partial preserving and the rest four patients underwent LRP without NVB preservation. The median Foley catheter indwelling periods were 4 days (IQR 4–8.5). There is no anastomosis leakage in the cystograms among seven patients (78%). Five patients (56%) got immediate continence control at the first day of Foley catheter removal. The other four patients with mild stress urinary incontinence showed improvement within 3 months.

Conclusions:

Retzius-sparing LRP is a feasible option for localized prostate cancer in our initial experiences. It might result in early continence control and is definitely with less economic cost for patients. Further long-term prospective studies are needed.

No competing financial interests exist.

Runtime of video: 7 mins 38 secs