Retzius-Sparing Robot-Assisted Robotic Prostatectomy: Past, Present, and Future.

Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.

Historical Considerations and Surgical Quality Improvement in Robotic Prostatectomy.

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.

La prostatectomía radical retropúbica: orígenes y evolución de la técnica / Radical retropubic prostatectomy: Origins and evolution of the technique

OBJETIVO: Revisión histórica de los orígenes y de la evolución técnica de la prostatectomía retropúbica en el cáncer de próstata. MATERIAL Y MÉTODO: Revisión fundamentalmente de los artículos originales sobre el diseño de las técnicas de prostatectomía retropúbica. RESULTADOS: Es posible que la primera prostatectomía se realizara a principios del s. xix. Millin (1945) abrió el camino de la prostatectomía retropúbica al diseñar el acceso retropúbico a la próstata. Memmelaar (1949) estructuró la prostatectomía retrógrada. Campbell diseñó la prostatectomía anterógrada (1959). Walsh (1983), basándose en trabajos anatómicos, diseñó la técnica de prostatectomía retrógrada con preservación de la función sexual. CONCLUSIÓN: Las aportaciones técnicas acumuladas durante aproximadamente 80 años concluyeron con la descripción de la técnica de Walsh, que se considera en la actualidad la técnica estándar de prostatectomía retropúbica

OBJECTIVE: Historical review of the origins and technical evolution of retropubic prostatectomy in prostate cancer. MATERIAL AND METHOD: Review of original articles on the design of retropubic prostatectomy techniques. RESULTS: The first prostatectomy could have been performed in the early 19 th century. Millin (1945) opened the way for retropubic prostatectomy with the retropubic access design. Memmelaar (1949) structured retrograde prostatectomy. Campbell designed antegrade prostatectomy (1959). Based on anatomical studies, Walsh (1983) designed retrograde prostatectomy with preservation of sexual function. CONCLUSION: Technical inputs accumulated over approximately 80 years concluded with the description of the Walsh technique, which is currently considered the standard technique for retropubic prostatectomy

La prostatectomía radical retropúbica: control del plexo venoso de Santorini / Radical retropubic prostatectomy: control of Santorini's venous plexus

OBJETIVO: Revisión histórica de los procedimientos y maniobras descritos en la literatura para el control del plexo venoso de Santorini. MATERIAL Y MÉTODO: Revisión, fundamentalmente de los artículos originales, sobre el diseño de procedimientos y maniobras para el control del plexo venoso de Santorini. RESULTADOS: El control del plexo venoso de Santorini es fundamental para reducir las pérdidas hemáticas y disecar el ápex prostático. El primer control lo realizó Chute en 1954. Posteriormente varios autores (Reiner y Walsh, Hayashi, Myers, etc.) publicaron distintas maniobras para su control. CONCLUSIÓN: No existe el procedimiento o la maniobra ideal para el control del plexo de Santorini

OBJECTIVE: Historical review of the procedures and maneuvers described in the literature for the control of Santorini's venous plexus. MATERIAL AND METHOD: Review of original articles on the design of procedures and maneuvers for the control of the Santorini's venous plexus. RESULTS: The control of Santorini's plexus is crucial to reduce blood loss and dissect the prostatic apex. The procedure was first performed by Chute in 1954 and has undergone subsequent modifications by several authors (Reiner and Walsh, Hayashi, Myers, etc.) who have published different maneuvers for its control. CONCLUSION: There is no ideal procedure or maneuver for the control of the Santorini's plexus

La prostatectomía radical retropúbica: anastomosis vesico-uretral / Radical retropubic prostatectomy: Vesicourethral anastomosis

OBJETIVO: Revisión histórica de los procedimientos y maniobras descritos en la literatura para la realización de la anastomosis vesico-uretral después de la prostatectomía retropúbica. MATERIAL Y MÉTODO: Revisión fundamentalmente de los artículos originales sobre el diseño de maniobras para la realización de la anastomosis vesico-uretral. RESULTADOS: Se han descrito numerosas maniobras para facilitar la anastomosis vesico-uretral. Las que utilizan un catéter elástico o un catéter metálico o endoscopios son las más numerosas. CONCLUSIÓN: No existe la maniobra ideal para la realización de la anastomosis vesico-uretral después de la prostatectomía retropúbica. Probablemente la maniobra de Gil-Vernet al no necesitar instrumentación especial sea la más sencilla de realizar y con la que se logra intrabdominalizar un segmento mayor de uretra

OBJECTIVE: Historical review of the procedures and maneuvers described in the literature for the performance of vesicourethral anastomosis (VUA) after retropubic prostatectomy. MATERIAL AND METHOD: Review of the main original articles on the design of VUA maneuvers. RESULTS: Various techniques have been described to facilitate VUA, the most common being those with soft or hard catheters, or endoscopes. CONCLUSION: There is no perfect technique for the performance of VUA after retropubic prostatectomy. Since it does not require specific instrumentation, the Gil-Vernet maneuver may be the technique through which a longer urethral segment is transferred inside the abdomen and the easiest to perform

Radical retropubic prostatectomy: Vesicourethral anastomosis. / La prostatectomía radical retropúbica: anastomosis vesico-uretral.

OBJECTIVE: Historical review of the procedures and maneuvers described in the literature for the performance of vesicourethral anastomosis (VUA) after retropubic prostatectomy. MATERIAL AND METHOD: Review of the main original articles on the design of VUA maneuvers. RESULTS: Various techniques have been described to facilitate VUA, the most common being those with soft or hard catheters, or endoscopes. CONCLUSION: There is no perfect technique for the performance of VUA after retropubic prostatectomy. Since it does not require specific instrumentation, the Gil-Vernet maneuver may be the technique through which a longer urethral segment is transferred inside the abdomen and the easiest to perform.

Radical retropubic prostatectomy: control of Santorini's venous plexus. / La prostatectomía radical retropúbica: control del plexo venoso de Santorini.

OBJECTIVE: Historical review of the procedures and maneuvers described in the literature for the control of Santorini's venous plexus. MATERIAL AND METHOD: Review of original articles on the design of procedures and maneuvers for the control of the Santorini's venous plexus. RESULTS: The control of Santorini's plexus is crucial to reduce blood loss and dissect the prostatic apex. The procedure was first performed by Chute in 1954 and has undergone subsequent modifications by several authors (Reiner and Walsh, Hayashi, Myers, etc.) who have published different maneuvers for its control. CONCLUSION: There is no ideal procedure or maneuver for the control of the Santorini's plexus.

Radical retropubic prostatectomy: Origins and evolution of the technique. / La prostatectomía radical retropúbica: orígenes y evolución de la técnica.

OBJECTIVE: Historical review of the origins and technical evolution of retropubic prostatectomy in prostate cancer. MATERIAL AND METHOD: Review of original articles on the design of retropubic prostatectomy techniques. RESULTS: The first prostatectomy could have been performed in the early 19th century. Millin (1945) opened the way for retropubic prostatectomy with the retropubic access design. Memmelaar (1949) structured retrograde prostatectomy. Campbell designed antegrade prostatectomy (1959). Based on anatomical studies, Walsh (1983) designed retrograde prostatectomy with preservation of sexual function. CONCLUSION: Technical inputs accumulated over approximately 80 years concluded with the description of the Walsh technique, which is currently considered the standard technique for retropubic prostatectomy.

Considering the role of radical prostatectomy in 21st century prostate cancer care.

The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men - a large cohort of ~40% of men with newly diagnosed prostate cancer - were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7-9 or Grade Groups 2-5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.

[Radical prostatectomy through the years]. / Die radikale Prostatektomie im Wandel der Zeit.

The operative aspect of radical prostatectomy has changed dramatically in the past 200 years as significant technological advances have been made, particularly during the past 50 years. The work of Dr. Walsh in the late 1970 s and early 1980 s led to a significant reduction in surgical morbidity and is considered an important milestone of radical prostatectomy, as is the introduction of minimally-invasive (robotic-assisted) surgical techniques. Yet there is no absolute gold standard regarding surgical approaches. Innovative tools, e. g. the addition of "augmented reality", are currently under investigation. This review article for the anniversary issue of "Der Urologe" aims to cover the milestones of the evolution of this "signature" surgery in the field of urology.

Robotic surgery in urology: facts and reality. What are the real advantages of robotic approaches for prostate cancer patients?

PURPOSE OF REVIEW: Despite the worldwile increasing use of robotic assistance for oncology surgery, no level 1 evidence-based benefit favoring robot-assisted radical prostatectomy (RARP) versus pure laparoscopic or open approaches has been demonstrated. We aimed to perform an update of the available evidence by evaluating most recent 2016-2017 data. RECENT FINDINGS: Population-based and prospective nonrandomized studies and one phase III randomised trial have been recently published. Early results from the phase III trial suggested that RARP led to similar early functional and oncologic outcomes compared with open radical prostatectomy. Shorter operative time, hospital stay, and lower complications rate and blood loss were reported in RARP group compared with open radical prostatectomy group. Population-based data did not demonstrate any benefit from one approach over another in terms of functional and oncologic outcomes. Robot assistance is predictive for improved potency recovery in organ-confined tumor in one large prospective trial. Main limitations, different among studies, were lack of randomization or single operator cohorts, short-term follow-up, and absence of confounding factors analysis. SUMMARY: Robotic assistance seems to confer better results than open radical prostatectomy procedures in terms of intra- and immediate postoperative parameters (operative time, blood loss and hospital stay). Clear advantages of one technique over another on robust functional or oncologic endpoints remain unproven.

[The life and works of Professor Max Hösel (1906-1971): a pioneer of endoscopic prostate surgery]. / Das Leben und Wirken von Professor Max Hösel (1906-1971) : Ein Pionier der endoskopischen Prostatachirurgie.

In 1949 Max Hösel (1906-1971) founded the largest urological hospital in the world at that time in the former military hospital in Ulm, which at times had over 250 inpatient beds. In the south German region he had at his disposal the most comprehensive endoscopic operation collective and the greatest experience in transurethral resection of the prostate (TUR-P). From 1948 to 1958 he carried out approximately 13,850 prostate resections with an average adenoma weight of 30 g and a mortality rate of <1%. The technical inadequacies of the resection instruments at that time prompted Hösel to develop a new form of resectoscope, namely the type 782. This resectoscope allowed a fast and complete resection of prostatic adenomas due to the improved visual field and better handling (rotating the operational unit) and also made the transurethral resection of larger prostatic adenomas possible. Therefore, in "Ulm and around Ulm" substantially larger prostatic adenomas could be endoscopically treated and open enucleation was not necessary. Prof. Hösel was an international force as a urologist and in Germany was ranked as one of the pioneers in the field of endoscopic prostate surgery. Although he never held the position of a University Chair, in the municipal hospitals in Ulm he accomplished the foundations for the later University Clinic for Urology.

The history of calculus mendax and the following surgery on the prostate.

In this paper we would like to present probably the first surgery performed on the prostate gland followed by microscopic analysis of the obtained tumor tissue sample. We based on the existing correspondence between Ludwig von Hammen and Johann N. Pechlin, and their successors in this field as well. Von Hammen seems to be a pioneer in the area of not only urological surgery but in directing this part of medical practice from "lithotomists" to physicians, much better educated than barbers in physiology but first of all in anatomy. This 17th century physician from Gdansk tried to set new standards both for surgical medical practice but histopathological examination of the excised material as well. Due to the change of the operational skills and procedures von Hammen's work got almost forgotten, but remains remembered due to the work of historians of the medicine from following centuries.