ABSTRACT
【Objective】 To investigate the safety, feasibility and clinical efficacy of modified anterior robot-assisted laparoscopic radical prostatectomy (RALRP) with preservation of Retzius space. 【Methods】 The clinical data of 10 patients who underwent RALRP using the modified anterior approach to preserve the Retzius space in our hospital during June 2021 and March 2022 were retrospectively analyzed, including the preoperative, intraoperative, postoperative and follow-up data. 【Results】 All operations were successful without conversion to open surgery. The average operation time (robotic arm operation time) was (98.6±47.7) min, blood loss (105.0±57.3) mL, postoperative drainage tube indwelling time (5.3±1.3) d, postoperative urinary catheter indwelling time (7.2±0.8) d, and postoperative hospital stay (9.2±2.2) d. Urinary continence was achieved immediately after removal of the urinary catheter in 6 patients, 2 patients recovered 2 weeks after extubation, and 2 patients recovered 3 months after extubation. Postoperative pathology showed pT2a stage in 1 case, pT2b stage in 2 cases, and pT2c stage in 7 cases; Gleason score was 6-7 points; all postoperative resection margins were negative. During the follow-up of 3-12 months, no tumor recurrence was observed, and no patient was readmitted due to surgical complications. 【Conclusion】 RALRP with modified anterior approach to preserve the Retzius space is safe and feasible, with no serious complications during and after surgery, and the early postoperative urinary continence effect is comparable to that of the posterior approach.
ABSTRACT
Background: Casual internet surfing at times proves extremely rewarding with astonishing results. Chance finding of an unknown old PhD thesis prompted documentation of detailed description of retropubic spaces supplementary to the author’s recent publication (Ansari MM. Ann Int Med Den Res 2017; 3(5): SG25-31.). Methods: Prospective study in adult patients with inguinal hernia who underwent laparoscopic total extra-peritoneal preperitoneal (TEPP) hernioplasty through standard 3-midline-port technique at J. N. Medical College, Aligarh between 2010 and 2015. Results: Under excellent fibre-optic light and magnified view during preperitoneal laparoscopy, multiple potential retropubic spaces were observed in the retropubic region, ranging from 4 to 7 in number. A total of four fissile potential retropubic spaces were recognized in 46 cases of TEPP hernioplasty when the posterior rectus sheath was incomplete (single- or double-layered) and the preperitoneal fascia as well as transversalis fascia was single-layered; a total of five fissile potential retropubic spaces were observed when preperitoneal fascia was double-layered along with presence of a single- or double-layered incomplete posterior rectus sheath (N=8); a total of five fissile potential retropubic spaces was also observed when the preperitoneal fascia was single-layered and the posterior rectus sheath was found single-layered but complete extending upto the pubic bone (N=10); a total of six fissile potential retropubic spaces were observed when the preperitoneal fascia was double-layered along with the presence of a single-layered complete posterior rectus sheath (N=3); and a maximum of seven fissile potential retropubic spaces was recognized, given the presence of a double-layered complete posterior rectus sheath and a double-layered preperitoneal fascia at the same time (N=1). Conclusion: Instead of a single Retzius space, multiple loosely fissile potential interfascial spaces (4-7) were documented in retropubic region, necessitating re-evaluation of Retzius space anatomy, in order to help TEPP hernia surgeon to execute the procedure with ease, rapidity and safety.
ABSTRACT
Objective To compare the postoperative outcomes and early continence rate between conventional robot-assisted laparoscopic radical prostatectomy (RARP) and Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RSRARP).Methods The date from 50 patients who underwent RSRARP and 122 patients who underwent conventional RARP between 2016 September to 2017 included study.Ninety-two patients (forty-six patients in RARP group and forty-six patients in RSRARP group) were collected by propensity-score matching which were performed using eight preoperative variables.Preoperative data of patients in RSRARP group [patients age (67.1 ± 5.7) years,BMI (24.6 ± 2.7) kg/m2,tPSA 10.7 ng/ml (0-40.7 ng/ml),Gleason score 7 points (6-9 points),prostate volume 31.9 ml (10.0-95.4 ml),ECOG score 0 points (0-1 points),urinary domain of EPIC 94.8 points (63.9-100 points),clinical stage from T1cN0 M0 to T3a N0 M0] and conventional RARP group [patients age (67.2 ± 6.7) years,BMI (25.2 ± 3.1) kg/m2,tPSA 10.7 ng/ml (0-40.7 ng/ml),Gleason score 7 points (6-9 points),prostate volume 36.8 ml (8.9-81.0 ml),ECOG score 0 points (0-1 points),urinary domain of EPIC 95.8 points (63.9-100.0 points),clinical stage from T1c N0Mo to T3a N0M0] had no significant differences.We reviewed console time,estimated blood loss,the rate of leakage,complications,average daily drainage,pathological result,continence,urinary domain of EPIC one month,two months and three months after operation.Results All 92 cases were successfully performed robotically.Mean operation time was significantly more in RARP group than in RSRARP group [(223.9 ±48.9) min vs.(198.91 ±34.2)min,P ＜ 0.05)].There was no significant difference between the postoperative data of patients in RSRARP group [estimated blood loss 200 ml (50-1 200 ml),average daily drainage 82.5 ml (11.7-571.0 ml),the rate of leakage 6％,Clavien-Dindo grade Ⅰ (9％),Clavien-Dindo grade Ⅱ (4％),pathological stage pT1 (2％),pT2 (52％),pT3 (46％)] and RARP group [estimated blood loss 200 ml (100-1 200 ml),average daily drainage 102.9 ml (23.3-534.7 ml),the rate of leakage 4％,Clavien-Dindo grade Ⅰ (9％),Clavien-Dindo grade Ⅱ (2％),pathological stage pT1 (0),pT2 (46％),pT3 (54％)] (P ＞ 0.05).Early continence rate one week and one month after surgery was significantly higher in RSRARP group than in RARP group (78％ vs.35％,91％ vs.79％,P＜0.05).Urinary domain of EPIC one month and two months after surgery was significantly more in RSRARP group than in RARP group [(91.4±8.3) vs.(84.6±10.9),(95.0±7.5) vs.(91.6±7.8),P＜0.05].There was no significant difference in the rate of positive surgical margin between RSRARP group and RARP group (22％ vs.17％,P ＞ 0.05).Conclusions RSRARP were time-saving,safe and effective for the surgical treatment of localized prostate cancer.It seemed to yield a better outcome regarding early return to urinary continence postoperatively.