New Evolution of Robotic Radical Prostatectomy: A Single Center Experience with PERUSIA Technique

Abstract

Radical prostatectomy (RP) is the standard surgical treatment of organ-confined prostate cancer in patients with a life expectancy of at least 10 years. In a recent prospective study, we described the PERUSIA (Posterior, Extraperitoneal, Robotic, Under Santorini, Intrafascial, Anterograde) technique, which is an extraperitoneal full nerve sparing robotic RP, showing its feasibility and safety. The aim of this retrospective study was to evaluate the peri-operative, oncologic, and functional outcomes of the PERUSIA technique. We retrospectively analyzed the data of 454 robotic-assisted radical prostatectomies (RARP) performed using the PERUSIA technique from January 2012 to October 2019. We evaluated perioperative outcomes (operative time, estimated blood loss, catheterization time, complication rate, length of stay), oncological (positive surgical margins and biochemical recurrence), and functional outcomes in terms of urinary continence and sexual potency. The overall complication rate was 16%, positive surgical margins were 8.1%, and biochemical recurrence occurred in 8.6% at median follow-up of 47 months. Urinary continence was achieved in 69% of cases the day after the removal of the catheter, in 92% at 3 months, and in 97% at 12 months after surgery. The average rate of sexual potency was 72% and 82% respectively 3 and 12 months after surgery. Our findings show that the PERUSIA technique is a safe extraperitoneal approach to perform a full nerve sparing technique providing exciting functional outcomes.

De Novo Detrusor Underactivity and Other Urodynamic Findings after Radical Prostatectomy: A Systematic Review

“…Despite differences, they aim in reducing injury to neurovascular bundles due to respect of anatomical details and avoidance of traction. In a recently published study by Cochetti et al, a novel RALP technique meeting these goals was validated as safe and effective with good functional outcomes [ 3 ].…”

“…Moreover, novel tools based on genetic alterations and epigenetic interactions are evaluated for the determination of indolent or aggressive tumour behaviour [ 2 ]. This phenomenon resulted in a growing interest in novel surgical techniques that would limit the functional morbidity of RP [ 3 ]. The impact of the surgery on men’s well-being is well documented.…”

Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome

“…20,21 However, with the number of RALPs and the surgical experience in this field steadily increasing, new techniques for intra-and extraperitoneal nerve sparing prostatectomy are emerging, steadily improving the functional postoperative outcomes. 22,23 In partial nephrectomy and radical nephrectomy, the status of robotic surgery is still under investigation, with a recent review of 16 comparative studies showing no differences in the surgical margin status, the change of glomerular filtration rate and transfusion rate between the two groups. Hereby, robot-assisted partial nephrectomy had a longer operative and warmer ischemia time, but showed slightly lower perioperative blood loss, hospital stay, and perioperative complications.…”

“… 20 , 21 However, with the number of RALPs and the surgical experience in this field steadily increasing, new techniques for intra- and extraperitoneal nerve sparing prostatectomy are emerging, steadily improving the functional postoperative outcomes. 22 , 23 …”

The Challenges of Patient Selection for Prostate Cancer Focal Therapy: A Retrospective Observational Multicentre Study

“…For all the others, except the locally advanced, a local treatment, if feasible, should be proposed in personalised medicine [ 2 , 6 ]. Unfortunately, radical prostatectomy, even if nerve-sparing and radiotherapy, are not free of side effects [ 7 , 8 ]. For surgery, incontinence and erectile dysfunction rate are reported to be 31% and 38% at 12 months, respectively, if nerve-sparing techniques are performed [ 9 , 10 ].…”