The Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: report of 8 cases

Huang Shuang; Ma Xin; Zhu Jie; Huang Qingbo; Aldo Massimo Bocciardi; Zhang Xu

doi:10.19558/j.cnki.10-1020/r.2017.04.002

Abstract：Objective:To investigate the feasibility of the Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RARP) and report the functional and oncologic results of our first 8 cases.Methods:From June 2013 to January 2017,8 patients with clinically localized prostate cancer underwent this new approach for RARP.The patients were aged from 56 to 71 years old (mean 64),and the BMI was 19.7-24.1 kg/m2 (mean 21.6 kg/m2).The mean preoperative PSA was 7.50 (4.18-11.04) μg/L.Six patients had IIEF-5 ≥21,and 2 IIEF-5 <21.For the biopsy Gleason Score,7 patients were scored 3+3=6,and the other 1 was scored 3+2=5.All of them were in a low D''Amico risk classification.The operation was performed using a 4 arm da Vinci Si operating system,and theworking channel was set up transperitoneally.The parietal peritoneum was incised at the anterior surface of the Douglas space.Seminal vesicles and deferens vasa were isolated and incised.Denonvillier''s fascia was separated by the posterolateral surface of the prostate in an antegrade direction,reaching the prostatic apex,and then the bladder neck was isolated and dissected.The NVB was dissected using double interrupted titanium clips.The resected prostate was placed in a specimen bag after dissecting the prostatic apex.The anastomosis was performed using a continuous suture starting from the 12 o''clock position.The parietal peritoneum at the Douglas space level was finally closed.Results:All the operations were successfully performed.The total operative time was 75-120 min (mean 90 min).The blood loss was 50-200 mL (mean 110 mL) and no blood transfusion was required.Pathologic stage was pT2a in 5 patients,pT2b in 2 patients and pT2c in 1 patient,with positive surgical margin in one case.The postoperative pathologic Gleason score was 3+2=5 in 1 patient,3+3=6 in 6 patients,and 3+4=7 in 1 patient.The catheter was removed after a mean of 17 (range:14-21) days.No intra-operative complications occurred.The mean hospital stay was 5 (mean 4-7) days after surgery.All the cases were continent after removal of the catheter.No cases demonstrated vesicourethral stricture and biochemical recurrence during a postoperative follow-up period of 4-41 months.Three months after the operation,6 patients had satisfactory erectile function (IIEF-5 ≥21).Conclusions:The Retzius-sparing RARP is oncologically safe and results in high early continence and potency rates.Long-term,prospective,comparative,and possibly randomized studies are needed.