Curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy through anterior path / 中华泌尿外科杂志

Objective To investigate the curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy(RARP) through anterior path.Methods From July 2015 to July 2017,75 patients undergoing Retzius sparing RARP(Rs-RARP group) and 75 patients undergoing conventional anterior approach RARP(CA-RARP group) were retrospectively reviewed.Preoperative data of patients was collected as follows:age of (68.6 ± 5.3) years,median prostate volume of 38.9 (20.6-60.1) m1,tPSA of (15.7 ± 3.3) ng/ml,BMI of (25.2 ± 3.6) kg/m2,biopsy Gleason score of 3 + 3 in 24 cases,3 + 4 in 28 cases,4 + 3 in 23 cases,cTMN T1c in 11 cases,T2a-T2b in 59 cases,T2c in 5 cases,in Rs-RARP group;age of (69.6 ± 5.6) years,median prostate volume of 38.3 (18.4-59.8)ml,tPSA of (17.6 ± 4.4) ng/ml,BMI of (27.5 ± 2.7) kg/m2,biopsy Gleason score of 3 + 3 in 29 cases,3 + 4 in 26 cases,4 + 3 in 20 cases,cTMN T1c in 17 cases,T2a-T2b in 51 cases,T2c in 7 cases,in CA-RARP group.The clinical data of the two groups,including operation time (OT),intraoperative blood loss,perioperative blood transfusion rate,24h/1m/3m/6m/12m continence situation and erectile function recovery,and postoperative oncological results were analyzed statistically.Results All cases were successfully performed robotically without conversion or major intraoperative or postoperative complications.For operative time,Rs-RARP group was (125.3 ± 15.6) mins and CA-RARP group was (108.4 ± 21.7) mins,and the difference was not statistically significant (P ＞ 0.05).For estimated blood loss (EBL),Rs-RARP group was (106.1 ± 10.3) ml,with perioperative blood transfusion in 2 cases (2.67％),and CA-RARP group was (82.2 ± 18.4)ml,with perioperative blood transfusion in 1 cases(1.33％).The Rs-RARP group had more EBL than the CA-RARP group(P ＜0.05).No difference was found in perioperative blood transfusion rate(P ＞ 0.05).The postoperative oral intake time was (1.5 ± 0.6) d,postoperative hospital stay was (8.0 ± 1.2) d,total hospitalization expense was (58.4 ± 13.2) thousand Yuan,and there were 5 cases (6.67％) with postoperative complications in Rs-RARP group,and was (2.0 ±0.6) d,(9.0 ± 1.8) d,(60.2 ± 16.4)thousand Yuan and 3 cases (4.00％) in corresponding items in CA-RARP group.No significant difference was found in the above mentioned parameters (all P ＞ 0.05).Postoperative pathology confirmed pT1c of 18 cases,T2a-T2b of 52 cases,and pT2c of 5 cases in Rs-RARP group and pT1c of 12 cases,T2a-T2b of 56 cases,pT2c of 7 cases in CA-RARP group (P ＞ 0.05).There was no significant difference between RsRARP and CA-RARP groups in the surgical positive margin (5 cases vs.4 cases,P ＞ 0.05).No tumor recurrence appeared for all cases (tPSA ＜0.2 ng/ml) during 12 months follow-up.The continence rate for Rs-RARP group and CA-RARP group were 84.0％ (63/75) vs.28.0％ (21/75) (24h postoperatively),90.7％ (68/75) vs.46.7％ (35/75) (1 month postoperatively),93.3 ％ (70/75) vs.57.3％ (43/75)(3 months postoperatively),96.0％ (72/75) vs.89.3％ (67/75) (6 months postoperatively) and 100％ (75/75) vs.96.3％ (72/75) (1 year postoperatively).Rs-RARP group showed superiority in continence recovery at 24 h and 1,3 months postoperatively (all P ＜ 0.05),but no statistical differences at 6,12 months postoperatively(all P ＞ 0.05).On erectile function,Rs-RARP group was significantly better than the conventional group at 1,3,6,12 months postoperatively in ≤75-year-old patients(all P ＜ 0.05).But in ＞ 75-year-old patients,two groups had no difference during the follow-up (all P ＞ 0.05).Conclusions Retzius sparing RARP through anterior path can treat early and intermediate stage prostate cancer effectively,and continence and erectile function recovered shortly.

Retzius-sparing robot-assisted laparoscopic radical prostatectomy for early-stage prostate cancer (with video) / 中华男科学杂志

Objective@#To investigate the application of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in the treatment of early-stage prostate cancer.@*METHODS@#We retrospectively analyzed the clinical data about 10 cases of early-stage prostate cancer treated by RS-RARP with the Da Vinci Robot Surgical System from September to October 2016.@*RESULTS@#All the operations were successfully completed without positive surgical margins. The operation time was 170－250 min (［196±25］ min), the intraoperative blood loss was 150－500 ml (［260±128］ ml), the postoperative hospital stay was 6－7 days, and the catheterization time was 14 days. Urinary continence occurred after catheter removal in 1 patient and was recovered 1 month later.@*CONCLUSIONS@#RS-RARP is a safe, effective and reliable method for the treatment of prostate cancer and conducive to the early recovery of urinary continence.

A comparative study of Retzius-sparing technique with veil of Aphrodite technique nerve sparing robotic-assisted laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective To introduce the technique and report our initial experience of Retziussparing robotic-assisted laparoscopic radical prostatectomy (RALP) and compare perioperative outcomes with the standard veil of Aphrodite technique (Veil technique).Methods nineteen Retzius-sparing RALP and 20 Veil nerve sparing RALP with posterior reconstruction for T1c to T2c prostate cancer performed by a single surgical team between 2015 January and 2016 December were retrospectively reviewed.Preoperative data of patients in Retzius-sparing group [patient age (66.3 ± 5.9) years,BMI (25.5 ± 3.1) kg/m2,tPSA (16.4 ± 5.0) ng/ml,biopsy Gleason score 6 (5-7),prostate volume (32.7 ± 7.4) ml and IIEF-5 score 14(5-18)] and Veil group[patient age (64.6 ±7.3) years,BMI (25.5 ±2.0) kg/m2,tPSA (18.5 ± 11.0) ng/ml,biopsy Gleason score 7(5-8),prostate volume (31.4± 10.8)ml and IIEF-5 score 15(6-19)].No significant difference was found between the two group in the above parameters (all P ＞ 0.05).All patients were continent preoperatively.Retzius-sparing RALP and Veil nerve sparing RALP were performed via transperitoneal RALP.Operative time,estimated blood loss,postoperative hospital stay,postoperative staging,postoperative Gleason score,return of urinary continence and postoperative IIEF-5 score of the two groups were statistically analyzed.Results All 39 cases were successfully performed robotically without conversion,transfusion or other major intraoperative and postoperative complications.Postoperative pathology confirmed pT2a 5 cases,pT2b 8 cases and pT2c 6 cases in Retzius-sparing group and pT2a 7 cases,pT2b 5 cases and pT2c 8 cases in Veil group (all P ＞ 0.05).For Retzius group,operative time was (106.5 ± 26.4) min and estimated blood loss was (48.9 ± 20.2) ml;for Veil group,operative time was (93.2± 20.8) min and estimated blood loss was (42.5 ± 16.8) ml.No significant difference was found in the above parameters (all P ＞ 0.05).Urethral catheter was removed at postoperative 7-day (Retzius-sparing group) and 21-day (Veil group),respectively.18 patients in Retzius-sparing group achieved urinary continence (0 pads) immediately after the removal of urinary catheter,while 1 patient returned to full continence in 2 weeks postoperatively.Patients in Veil group returned to continence (6.8 ± 3.6) weeks postoperatively (P ＜ 0.001).At 3-month follow up,IIEF-5 score was 14 (4-16) in Retziussparing group and 14 (4-18) in Veil group;no significant changes was noted in preoperative and postoperative IIEF-5 score in both groups,or in postoperative IIEF-5 scores in the two groups (P ＞ 0.05).No sign of tumor recurrence was appreciated for all cases (tPSA ＜ 0.2 ng/ml) during follow-up of 6 months (3 to 12 months).Conclusions Retzius-sparing RALP and the Veil nerve sparing RALP were both effective for the surgical treatment of localized prostate cancer.Our data revealed no statistical difference in perioperative outcomes between the two approaches,however,the Retzius-sparing technique seemed to yield a better outcome regarding early return to urinary continence postoperatively.