Complications of the First 500 Extra-Peritoneal Robot-Assisted Radical Prostatectomy (EP-RARP) Cases in an Italian Medium Volume Centre

Abstract

With a precise report of the morbidity related to EP-RARP, this study showed that complications were relatively frequent, but their severity was generally low.

Safety of robot-assisted radical prostatectomy in an Italian spoke hospital: Long-term oncologic and functional outcomes with median 11.3 years follow-up

“…Moreover, we have already demonstrated a very low morbidity of EP-RARP in our hands. 7 So, we could affirm that surgical prostate cancer care with robotic technology may reach optimal proficiency levels regardless hospital volume. As early adopters of the da Vinci technology, we tried to fill up the gap with high volume institutions with a continuous refinement of the procedure.…”

“…The three arms da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) platform was available since 2007, when it was upgraded with the fourth arms da Vinci S. Details about assessment and perioperative treatment of the patients were already described. 7 We adopted the extra peritoneal (EP) approach to perform RARP. The technical key points were an early adoption of the periurethral suspension stitch as described by Patel et al 8 and the reconstruction of the posterior rhabdomiosphincter according to the Rocco principle, 9 as a part of the vesico-urethral anastomosis, with the “Camposampiero stitch,” an initial 3/0 monofilament running suture involving the urethral stump at 6 o’-clock (in-out), the posterior part of the sphinteric complex, the remnants of the posterior Denonvilliers’ fascia and the “Guillonneau muscle” (anterior layer of Denonvilliers’ fascia or posterior detrusor apron) 10 and, finally, the bladder neck (out-in).The anastomosis was completed with two running sutures, starting at 5 and 7 o’-clock and tied together at 12 o’-clock.…”