Retzius-sparing Robot-assisted Radical Prostatectomy Research Articles

V45 - Retzius-sparing robot-assisted radical prostatectomy in high-risk prostate cancer patients

V45 - Retzius-sparing robot-assisted radical prostatectomy in high-risk prostate cancer patients

A1140 - Retzius-sparing robot assisted radical prostatectomy has similar 1-year functional and oncological outcomes as standard robot-assisted radical prostatectomy: Results from a high volume UK centre

A1140 - Retzius-sparing robot assisted radical prostatectomy has similar 1-year functional and oncological outcomes as standard robot-assisted radical prostatectomy: Results from a high volume UK centre

A1142 - Learning curve for Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP): Experience of two high volume UK surgeons

A1142 - Learning curve for Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP): Experience of two high volume UK surgeons

Pure single-port retzius-sparing robot-assisted radical prostatectomy with the da Vinci SP: Initial experience and technique description.

ObjectiveTo assess the feasibility and safety of pure single‐port (SP) retzius‐sparing robot‐assisted radical prostatectomy (RARP) using the da Vinci SP and describe the technique.Materials and MethodsFrom August 2020 to November 2020, data of 10 consecutive patients with localized prostate cancer, who underwent SP retzius‐sparing RARP, were prospectively collected. Patients demographics, intraoperative variables, postoperative complications, early oncological, and functional outcomes were assessed.ResultsThe patients were aged 46–73 years with a body mass index between 20.3 and 27.4 kg/m2. Prostate volumes ranged from 15 to 47.2 ml, with a median (interquartile range, IQR) PSA level of 7.4 (6.2–9.1) ng/ml. All surgeries were successfully completed without conversion. The median (IQR) operative and console time were 106 (101–109) min and 65 (63–68) min, respectively. The median (IQR) blood loss was 125 (50–150) ml, and one Clavien–Dindo grade I complication occurred. At 3 months, nine patients had undetectable PSA levels and all patients were continent.ConclusionsPure SP retzius‐sparing RARP could be safely performed using the da Vinci SP system, with acceptable surgical times and minimal complications. Future research will evaluate the advantages of this technique over the standard multiport robotic surgery.

Single-Port Retzius-Sparing Robot-Assisted Radical Prostatectomy: Feasibility and Early Outcomes.

Background: To determine safety and feasibility of single-port Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA) robotic platform in men with adenocarcinoma of the prostate. Patients and Methods: Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for perioperative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. Results: Mean (standard deviation) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m2. Mean preoperative prostate-specific antigen (PSA) was 10.2 ng/mL. Average prostate weight was 42 g. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in 24 (86%) patients and nerve sparing in 14 (46%) patients. Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for postoperative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration and dilation of bladder neck contracture). Pathologic grade group was group 1 (0%), group 2 (57%), group 3 (29%), and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA during follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Postoperative mean sexual health inventory for men score in those who underwent nerve sparing was 18 at 3 months follow-up. Conclusions: SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes requires longer follow-up and larger cohort validation.

Comparación entre la prostatectomía con preservación del espacio de Retzius y la prostatectomía radical estándar asistida por robot para el cáncer de próstata

Introduction and objectivesWe aim to compare the first year oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and standard robot-assisted radical prostatectomy (RARP). Materials and methodsEighty-eight patients who underwent robotic radical prostatectomy between 2018-2019 were included. We compared the minimum one-year follow-up results of patients who underwent Rs-RARP or RARP in terms of oncological and functional outcomes. Potency was assessed with the Sexual Health Inventory for Men (SHIM) score and was defined as an erection sufficient for penetration. Continence was defined as the absence of urinary incontinence with no safety pad. Patients were evaluated in the first month of follow-up and subsequently, every three months. ResultsForty-six patients in Rs-RARP and 42 patients in the RARP group were enrolled. Catheter removal time was shorter in the Rs-RARP group (12 vs. 14 days, P=.001). At the 1st month visit, 41 patients (%89) were continent (no pads) in the Rs-RARP group while 25 patients (%59) were continent in the RARP group (P=.001). Patients who underwent Rs-RARP achieved faster recovery of urinary continence (Log-rank, P=.001). After one year of follow-up, 43 patients (93%) in Rs-RARP group and 38 patients (90%) in RARP group were continent (P=.6). Potency rates were 38.7% in Rs-RARP and 34.4% in RARP group (P=.28). There were no cases of biochemical recurrence in any group. ConclusionsRs-RARP is a feasible technique, providing early return of continence. However, overall continence rates were similar at the end of the one-year follow-up.

Trifecta results in Retzius-sparing robotic radical prostatectomy: results of a high-volume center

Aim: We aimed to evaluate trifecta outcomes after Retzius-sparing robot-assisted radical prostatectomy (rs-RARP). Methods: We evaluated 1488 patients who had undergone rs-RARP at our institution from 2011 to 2019. All patients filled out questionaries for functional outcomes before surgery, and only patients with baseline continence and IIEF-5 scores of > 16 were included. Biochemical recurrence (BCR) was defined as two consecutive prostatic specific antigen levels of > 0.2 ng/mL after rs-RARP. Postoperative continence was defined as the use of no pads. Potency was defined as the ability to achieve erections for sexual intercourse, with or without phosphodiesterase-5 (PDE-5) inhibitors. A multivariable logistic regression model was performed to identify predictors of trifecta outcome. Results: In total, 1240 patients were included in the analysis. During the 24-month follow-up time, 149 patients (11.9%) harbored BCR. Urinary continence was observed in 981 patients (79.5%), while 171 (13.8%) still used a safety pad daily after 24 months. Sexual potency was reported in 643 patients (51.9%), of whom 379 (30.6%) had spontaneous erections and 264 (21.3%) used a PDE-5 inhibitor. Overall, the trifecta outcome was reached by 42.1% of the study’s population. The trifecta outcome was easily reached by younger patients and patients who underwent a full nerve-sparing (NS) prostatectomy. In the multivariable model, age [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.84-0.90; P < 0.01] and type of NS surgery [partial NS (OR = 3.34; 95%CI: 1.01-11; P = 0.04) full NS (OR = 4.57; 95%CI: 1.86-12; P < 0.01)] resulted as independent predictors. Conclusion: rs-RARP is associated with optimal trifecta outcome rate. Age and NS technique are independent predictors of trifecta outcomes.

Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.

Comparing Revo-i and da Vinci in Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Preliminary Propensity Score Analysis of Outcomes.

Purpose: This study aims to compare perioperative and oncologic outcomes between matched cohorts of localized prostate cancer (PCa) operated on by the same surgeon using the da Vinci Si robot and the Revo-i robot. Materials and Methods: Nonmetastatic PCa patients undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) from January 2016 to December 2020 were matched one-to-one (33:33) to da Vinci Si controls using propensity score matching according to the following covariates: age, American Society of Anesthesiology (ASA) score, body mass index, previous abdominal and endoscopic surgery, preoperative prostate specific antigen, prostate volume, Gleason grade group, tumor stage, and need for pelvic lymphadenectomy. Outcomes of interest were estimated blood loss, length of stay, complication rate, operative times, positive surgical margins, and biochemical recurrence at 6 months. Results: Both cohorts were similar in estimated blood loss, rate of margin positivity, and rate of complications. Length of stay was significantly shorter with the Revo-i cohort. The da Vinci robot showed faster console, suture, and total operation times. Positive margin rate and biochemical recurrence at 6 months were similar in both groups. Conclusion: Despite the longer suture, console, and operative time those in the da Vinci robot in the authors' institution, the Revo-i robot-assisted radical prostatectomy had equivalent short-term oncologic outcomes with the da Vinci standard.

Positive Surgical Margins Rate of Retzius-Sparing Robot-Assisted Radical Prostatectomy in a Contemporary, Unselected Cohort.

Our aim was to report the positive surgical margin (PSM) rate of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in an unselected, real-life cohort of patients treated at a fellowship-training urological department. Demographic, clinical and pathological data of 529 consecutive patients who underwent RS-RARP between January 2017 and December 2020 were collected prospectively and analyzed retrospectively in a hospital-approved audit in a European Association of Urology Robotic Urology Section (ERUS)-approved fellowship program. Overall PSM rates were reported for the entire cohort and for pT2 and pT3 patients separately. We defined clinically significant PSM as any length of >3 mm or multiple PSMs regardless of length. Median patient age was 64 years. More than 97% of the patients had intermediate or high-risk disease. The pathological stages were T2 (66.5%) and T3 (33.5%). Overall PSM was reported in 13.3% of pT2 patients and 28.9% of pT3 patients. Clinically significant PSM was reported in 43 patients (8.1%), and most of them (27 patients) had pT3 disease. Only 2.6% positive margins were reported at the apex and 0.7% on the anterior surface and bladder neck. Immediate continence (defined as no pads or 1 safety pad a day) rate was 65%. PSM rates of RS-RARP are acceptable and are higher in pT3 disease compared to pT2.

A propensity score-matching study on retzius-sparing robotic-assisted radical prostatectomy: Evidence of continence advantage on the early learning curve

To investigate the outcome of retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) compared with conventional RARP in the early learning curve. Consecutive patients with prostate cancer who underwent RS-RARP were included to compare against conventional RARP of the same period. Propensity-score matching was performed based on age, prostate size, nerve-sparing approach, and final pathological risk categories. All patients were re-admitted to undergo trial without Foley catheter from post-operative day 7-10. Clinical follow-up was performed with monitoring of continence (day 0, 3 months, and the latest continence during the study period) and surveillance of PSA level. Between July 2017 and August 2019, 24 consecutive patients received RS-RARP in our centre. Propensity score matching was performed with the best matched 24 controls receiving conventional RARP. Overall median follow-up duration was 15.5 months. A majority of the patients belonged to the intermediate-risk group, with most of them harbouring pT2 disease (RS-RARP: 87.5%; conventional RARP: 79.2%). More patients in RS-RARP group achieved day-0 continence (33.3% vs 0%, p=0.002) and 3-month continence (66.7% vs 12.5%, p=0.001). During the whole study period, more RS-RARP achieved continence with 0 pad (91.7% vs 66.7%, p=0.033). The mean months to continence is shorter in RS-RARP group (4.0 months vs 13.6 months, p=0.002). No statistically significant differences between the two groups with respect to surgical margins, post-operative PSA detection, and the use of adjuvant radiotherapy. RS-RARP showed better continence rates when compared to conventional RARP even during the learning curve phase.

Anterior vs. Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference?

Retzius-sparing Robotic Assisted Radical Prostatectomy (RS-RARP) is a novel surgical approach to radical prostatectomy. Its pioneers have suggested an improved recovery of urinary continence, while maintaining adequate cancer control. The aim of this systematic review was to explore available data on RS-RALP and compare functional, oncologic, and perioperative results of RS-RARP compared to anterior RARP. A search following PRISMA guidelines was performed including the combination of the following words: "Retzius" AND "sparing" AND "radical" AND "prostatectomy." Ninety-three articles were identified and 13 were included in the systematic review, including 3 randomized controlled trials (RCT), 4 prospective studies and 6 retrospective studies. All available randomized trials confirmed an improved immediate continence for RS-RARP, with rates ranging 51-71%, compared to 21-48% for anterior RARP. However, this advantage was progressively lost with no significant difference found after 6 months. Moreover, a prospective study found no discrepancy in terms of quality of life across the two techniques. Erectile function was difficult to compare, as patients had different baseline erectile function across studies and rate of neurovascular preservation was not comparable. Surgical approach remains controversial regarding positive margin rate, although related to the surgeon's experience and clinical stage. Biochemical recurrence-free survival appears similar between the two approaches. RS-RARP improves early urinary continence recovery compared to anterior RARP, with this advantage being lost after 3 to 6 months. Erectile function and quality of life were however comparable between the two techniques. The results concerning the rate of positive margins remained controversial. Future studies with longer follow-up are needed to better assess oncologic outcomes.

SC285 - Multiparametric prostate mri reduces the risk of positive surgical margins in high-risk prostate cancer patients treated with retzius-sparing robot assisted radical prostatectomy

SC285 - Multiparametric prostate mri reduces the risk of positive surgical margins in high-risk prostate cancer patients treated with retzius-sparing robot assisted radical prostatectomy

SC1 - High-risk prostate cancer patients treated with Retzius-Sparing robot-assisted radical prostatectomy at a single high volume centre

SC1 - High-risk prostate cancer patients treated with Retzius-Sparing robot-assisted radical prostatectomy at a single high volume centre

V12-09 THE ANATOMIC SCALENE TRIANGLE: A USEFUL LANDMARK FOR PELVIC LYMPHADENECTOMY DURING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-09 THE ANATOMIC SCALENE TRIANGLE: A USEFUL LANDMARK FOR PELVIC LYMPHADENECTOMY DURING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Jonathan Katz, Ali Merhe, Ali Mouzannar, and Mark Gonzalgo Jonathan KatzJonathan Katz More articles by this author , Ali MerheAli Merhe More articles by this author , Ali MouzannarAli Mouzannar More articles by this author , and Mark GonzalgoMark Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic lymphadenectomy (PLN) during Retzius-Sparing Robotic-Assisted Radical Prostatectomy (RS-RARP) may be challenging because the medial umbilical ligaments are not released, and the anterior structures are preserved. The incidence of symptomatic lymphoceles following PLN during RS-RARP has been reported to be higher than standard approaches for RARP. We describe the anatomic scalene triangle as a useful landmark to facilitate PLN during RS-RARP and compare the outcomes of PLN using this technique versus PLN for standard RARP. METHODS: This is a single center, institutional review board approved, retrospective case-control study of 200 consecutive patients undergoing RS-RARP or standard RARP. We compared perioperative factors such as age, BMI, grade group, tumor stage, lymph node yield, and incidence of symptomatic lymphoceles using t-test for continuous variables and Fisher’s exact test for categorical variables. A p-value of< 0.05 was considered statistically significant. In the RS-RARP, group the anatomic scalene triangle was used as a landmark for PLN. The scalene triangle is formed superiorly by the vas deferens, medially by the medial umbilical ligament, and laterally by the external iliac vein. The peritoneum overlying this triangle is incised superficially and an avascular plane in this space is developed. Retraction of the vas deferens and medial umbilical ligament facilitates exposure of the lymph node packet and the obturator nerve. Once the lymph node packet is isolated, surgical clips are applied and mobilization of the lymph nodes is performed cranially. Once the proximal extent of the dissection has been reached, the lymph node packet is divided and removed. RESULTS: There were no statistically significant differences between RS-RARP and standard RARP with respect to age, BMI, grade group, tumor stage, lymph node yield, or incidence of symptomatic lymphocele. Of note there were 4 symptomatic lymphoceles in the RS-RARP group and 1 symptomatic lymphocele in the standard RARP group. These were all treated with percutaneous drainage by interventional radiology. CONCLUSIONS: The anatomic scalene triangle is a useful landmark to facilitate safe and efficient PLN during RS-RARP and is associated with 4% incidence of symptomatic lymphoceles compared to prior, smaller series which demonstrated 8-16% incidence of symptomatic lymphoceles with PLN during RS-RARP. Though we observed more symptomatic lymphoceles in the RS-RARP group compared to standard RARP, this was not statistically significant. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1026-e1027 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Katz More articles by this author Ali Merhe More articles by this author Ali Mouzannar More articles by this author Mark Gonzalgo More articles by this author Expand All Advertisement Loading ...

MP15-08 LEARNING CURVE FOR RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY (RS-RARP): EXPERIENCE OF TWO HIGH VOLUME UK SURGEONS

INTRODUCTION AND OBJECTIVE:Retzius-Sparing Robot-Assisted Radical Prostatectomy (RS-RARP) has been shown to have better immediate functional outcomes, but with similar long-term oncological outcome...

3D Prostate Reconstruction and Cognitive Fusion to Improve Planning of Retzius Sparing Robotic Assisted Radical Prostatectomy (RS-RARP): Initial Report

50-years-old male with intermediate risk prostate cancer with PSA = 12, clinical stage p T2b and Gleason score = 7(3 + 4). Our propose was RS-RARP. Our figure comparing reconstruction performed at Docdo software and intraoperative endoscopic dissection shows to the perfect correlation between anatomic appearance of bladder neck and prostatic apex. The distance of midline and lateral border evaluate at 3D reconstruction facilitate surgeon to find the exact place between prostatic surface and neurovascular bundle to bilateral preservation.

P1105 - Retzius-sparing robot-assisted radical prostatectomy in high-risk prostate cancer patients: Results from a large single institution series

P1105 - Retzius-sparing robot-assisted radical prostatectomy in high-risk prostate cancer patients: Results from a large single institution series

P1103 - Retzius-sparing robot assisted radical prostatectomy has similar 1-year functional and oncological outcomes as standard robot-assisted radical prostatectomy: Results from a high volume UK centre

P1103 - Retzius-sparing robot assisted radical prostatectomy has similar 1-year functional and oncological outcomes as standard robot-assisted radical prostatectomy: Results from a high volume UK centre

P1106 - Multicentric experience in Retzius-sparing robot assisted radical prostatectomy performed by expert surgeons for high risk prostate cancer

P1106 - Multicentric experience in Retzius-sparing robot assisted radical prostatectomy performed by expert surgeons for high risk prostate cancer