V12-08 MODIFIED APICAL DISSECTION AND LATERAL PROSTATIC FASCIA PRESERVATION: PRELIMINARY ANALYSIS OF THE REPRODUCIBILITY OF THE NOVEL TECHNIQUE

Abstract

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-08 MODIFIED APICAL DISSECTION AND LATERAL PROSTATIC FASCIA PRESERVATION: PRELIMINARY ANALYSIS OF THE REPRODUCIBILITY OF THE NOVEL TECHNIQUE Bernardo Rocco, Luca Sarchi, Simone Assumma, Alessandra Cassani, Elena Morini, Filippo Turri, Cosimo De Carne, Carlo Bellorofonte, Paolo Marcangeli, Claudio Cesana, Giorgio Bozzini, Salvatore Micali, and Maria Chiara Sighinolfi Bernardo RoccoBernardo Rocco More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Simone AssummaSimone Assumma More articles by this author , Alessandra CassaniAlessandra Cassani More articles by this author , Elena MoriniElena Morini More articles by this author , Filippo TurriFilippo Turri More articles by this author , Cosimo De CarneCosimo De Carne More articles by this author , Carlo BellorofonteCarlo Bellorofonte More articles by this author , Paolo MarcangeliPaolo Marcangeli More articles by this author , Claudio CesanaClaudio Cesana More articles by this author , Giorgio BozziniGiorgio Bozzini More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , and Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Novel modified technique (mod-RALP) seems to improve functional outcomes in terms of continence and potency. Whereas these clear advantages, the issue of reproducibility of the technique has not been investigated. Moscovas et al reported their series of 104 patients (first 18 cases as a part of LC process); we aim to analyze the mod-RALP reproducibility with insights on safety and efficacy compared to standard approach. METHODS: A prospective study performed since October 2020, 20 patients with cT2 PCa undergo a mod-RALP (low-intermediate D’Amico risk group). PND was performed according to MSK nomogram, NS strategy according to PRECE tool. A single surgeon performed all procedures (BR). First transperitoneal anterior trocar placement (6 port). After bladder detachment and periprostatic fat excision, anterior bladder neck is opened followed by posterior bladder neck dissection. After seminal vesicle excision, the dissection goes caudally, in the posterior plane. The 0° camera allows blunt dissection toward the apex and lateral aspects of the prostate, avoiding energy use and sharp traumatic incisions. When a NS is planned, after posterior release, a plane medial to the lateral prostatic fascia is developed, leaving the NVBs unseen lateral to the fascial opening at the base. The anterior dissection continues underneath the puboprostatic ligament, preserving apical anatomy. Santorini plexus is controlled by a running barbed suture after the apical dissection and before the urethral division. Endpoints are time from bladder neck incision to urethral section; PSM rate stratified by pT, continence and potency at 30 days. RESULTS: Mod-RALP had no complication. Median time from bladder neck to urethral section was 42 min (DS 9). 16 patients had organ confined disease pT2 with no PSM, (25% had an apical localization of PCa), 1 pT3a, 1 pT3b and 1 pT4. As far as early continence and potency recovery all patients were continent at 30 days (safety pad in 2). All pre-op potent patients (IIEF 5>21) restored an erection sufficient for intercourse with the use of PDE-5i. CONCLUSIONS: From our preliminary experience, mod-RALP is reproducible without compromising oncological safety and operatory time. To our knowledge, this is the first case series testing the transferability of mod-RALP to an independent center. The careful dissection with maximal preservation of the apex enables a recovery of continence in all patients. Despite the single and high-volume surgeon characteristic of our series, the use of the mod-RALP should be furtherly encouraged. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1026-e1026 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernardo Rocco More articles by this author Luca Sarchi More articles by this author Simone Assumma More articles by this author Alessandra Cassani More articles by this author Elena Morini More articles by this author Filippo Turri More articles by this author Cosimo De Carne More articles by this author Carlo Bellorofonte More articles by this author Paolo Marcangeli More articles by this author Claudio Cesana More articles by this author Giorgio Bozzini More articles by this author Salvatore Micali More articles by this author Maria Chiara Sighinolfi More articles by this author Expand All Advertisement Loading ...