Anatomic nerve-sparing laparoscopic radical prostatectomy: Comparison of retrograde and antegrade techniques

Rassweiler, Jens; Wagner, Andrew A.; Moazin, Maher; Gözen, Ali Serdar; Teber, Doğu; Frede, Thomas; Su, Li-Ming

doi:10.1016/j.urology.2006.03.082

Cited by 42 publications

(16 citation statements)

References 31 publications

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“…The potency rates for RRP, LRP, and RARP are detailed on Table 10 17,23,24,32-34,59,60,65-68 Table 11, 33,38,40,41,[44][45][46]62,69 and Table 12. 35,48,51,53,63,64 As for continence, comparisons of the potency rates between different series are extremely difficult.…”

Section: Potency Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

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Section: Potency Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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“…There are two nerve sparing techniques, the antegrade dissection that starts at the base of the prostate and continues along the posterolateral contour to end in the posterior edge (7,20), and the retrograde, which starts at the apex and develops a plane between the rectum and the prostate to expose the medial border of the NVB. Retrograde dissection was the initially described technique for RRP, and it is characterized by a high incision of the fascia.…”

Section: Antegrade and Retrograde Dissectionsmentioning

confidence: 99%

“…The antegrade dissection has been applied primarily in LRP and it has been criticized because of the starting point of dissection that can be rather high, creating an intrafascial dissection, or very low, which would injure the nerves (7). In the principles of interfascial dissection of the NVB, skilled dissection and avoiding energy sources around the NVB are more important factors than the nerve-preservation technique used (20). …”

Section: Antegrade and Retrograde Dissectionsmentioning

confidence: 99%

Radical prostatectomy: evolution of surgical technique from the laparoscopic point of view

et al. 2010

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Purpose: To review the literature and present a current picture of the evolution in radical prostatectomy from the laparoscopic point of view. Materials and Methods:We conducted an extensive Medline literature search. Articles obtained regarding laparoscopic radical prostatectomy (LRP) and our experience at Institut Montsouris were used for reassessing anatomical and technical issues in radical prostatectomy. Results: LRP nuances were reassessed by surgical teams in order to verify possible weaknesses in their performance. Our basic approach was to carefully study the anatomy and pioneer open surgery descriptions in order to standardized and master a technique. The learning curve is presented in terms of an objective evaluation of outcomes for cancer control and functional results. In terms of technique-outcomes, there are several key elements in radical prostatectomy, such as dorsal vein control-apex exposure and nerve sparing with particular implications in oncological and functional results. Major variations among the surgical teams' performance and follow-up prevented objective comparisons in radical prostatectomy. The remarkable evolution of LRP needs to be supported by comprehensive results. Conclusions: Radical prostatectomy is a complex surgical operation with difficult objectives. Surgical technique should be standardized in order to allow an adequate and reliable performance in all settings, keeping in mind that cancer control remains the primary objective. Reassessing anatomy and a return to basics in surgical technique is the means to improve outcomes and overcome the difficult task of the learning curve, especially in minimally access urological surgery.

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“…Although great number of RARP surgeons employ the transperitoneal approach, others have advocated for extraperitoneal, the anterior approach, or a posterior approach to the seminal vesicles (SVs). The distinction between an ascending, retrograde dissection and a descending, antegrade dissection is also debated [18]. …”

Section: Introductionmentioning

confidence: 99%

Robotic-Assisted Radical Prostatectomy after the First Decade: Surgical Evolution or New Paradigm

Skarecky

2013

ISRN Urology

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Early studies indicate that robotic-assisted radical prostatectomy (RARP) has promising short-term outcomes; however, RARP is beyond its infancy, and the long-term report cards are now beginning. The important paradigm shift introduced by RARP is the reevaluation of the entire open radical prostatectomy experience in surgical technique by minimizing blood loss and complications, maximizing cancer free outcomes, and a renewed assault in preserving quality of life outcomes by many novel mechanisms. RARP provides a new technical “canvas” for surgical masters to create upon, and in ten years, has reinvigorated a 100-year-old “gold standard” surgery.

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Anatomic nerve-sparing laparoscopic radical prostatectomy: Comparison of retrograde and antegrade techniques

Cited by 42 publications

References 31 publications

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Radical prostatectomy: evolution of surgical technique from the laparoscopic point of view

Robotic-Assisted Radical Prostatectomy after the First Decade: Surgical Evolution or New Paradigm

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