Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes

Tappero, Stefano; Vecchio, Enrico; Palagonia, Erika; Longoni, Mattia; Martiriggiano, Marco; Granelli, Giorgia; Olivero, Alberto; Secco, Silvia; Bocciardi, Aldo Massimo; Galfano, Antonio; Dell’Oglio, Paolo

doi:10.1016/j.ejso.2023.03.218

Cited by 11 publications

(8 citation statements)

References 32 publications

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“…RS-RARP has emerged as a transformative technique in the management of localized PCa, offering patients the opportunity for curative treatment with acceptable morbidity [12]. RS-RARP has well-established advantages over the traditional RARP in terms of continence recovery [5,7], which has also been confirmed in challenging clinical presentations [20][21][22][23] and across different age groups [24].…”

Section: Discussionmentioning

confidence: 99%

“…Patient characteristics are a critical factor in mitigating ICs. Preoperative evaluation should consider factors such as prostate size, prior surgeries, radiations, and comorbidities, as these can influence the likelihood of complications [20][21][22][23]. Body mass index is particularly important, as obese patients with a BMI ≥ 30 kg/m 2 had a higher risk of symptomatic lymphoceles after RARP [30].…”

Section: Discussionmentioning

confidence: 99%

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A Comprehensive Overview of Intraoperative Complications during Retzius-Sparing Robot-Assisted Radical Prostatectomy: Single Series from High-Volume Center

Olivero,

Tappero,

Chierigo

et al. 2024

Cancers

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Background: Intraoperative complications (ICs) are invariably underreported in urological surgery despite the recent endorsement of new classification systems. We aimed to provide a detailed overview of ICs during Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: We prospectively collected data from 1891 patients who underwent RS-RARP at a single high-volume European center from January 2010 to December 2022. ICs were collected based on surgery reports and categorized according to the Intraoperative Adverse Incident Classification (EAUiaiC). The quality criteria for accurate and comprehensive reporting of intraoperative adverse events proposed by the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project were fulfilled. To better classify the role of the RS-RARP approach, ICs were classified into anesthesiologic and surgical ICs. Surgical ICs were further divided according to the timing of the complication in RARP-related ICs and ePNLD-related ICs. Results: Overall, 40 ICs were reported in 40 patients (2.1%). Ten out of thirteen ICARUS criteria were satisfied. According to EAUiaiC grading of ICs, 27 (67.5%), 7 (17.5%), 2 (5%), 2 (5%), and 2 (5%) patients experienced Grade 1, 2, 3, 4A, and 4B, respectively. When we classified the ICs, two cases (5%) were classified as anesthesiologic ICs. Among the 38 surgical ICs, 16 (42%) were ePNLD-related, and 22 (58%) were RARP-related. ICs led to seven (0.37%) post-operative sequelae (four non-permanent and three permanent). Patients who suffered ICs were significantly older (67 years vs. 65 years, p = 0.02) and had a higher median BMI (27.0 vs. 26.1, p = 0.01), but did not differ in terms of comorbidities or tumor characteristics (all p values ≥ 0.05). Conclusions: Intraoperative complications during RS-RARP are relatively infrequent, but should not be underestimated. Patients suffering from ICs are older, have a higher body mass index, a higher rate of intraoperative blood transfusion, and a longer length of stay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Comprehensive Overview of Intraoperative Complications during Retzius-Sparing Robot-Assisted Radical Prostatectomy: Single Series from High-Volume Center

Olivero,

Tappero,

Chierigo

et al. 2024

Cancers

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“…Despite its inner higher complexity, RS-RARP in patients with previous TURP is not associated with increased PSMs and with higher cost in terms of complications. 39 …”

Section: Methodsmentioning

confidence: 99%

Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

Ferretti,

Dell'Oglio,

Ciavarella

et al. 2023

RRU

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Robotic-assisted radical prostatectomy (RARP) is the gold standard for localized prostate cancer. Several RARP approaches were developed and described over the years, aimed at improving oncological and functional outcomes. In 2010, Galfano et al described a new RARP technique, known as Retzius-sparing RARP (RS-RARP), a posterior approach through the Douglas space that spares the anterior support structures involved with urinary continence and sexual potency. This approach has been used increasingly in many centers around the world comparing its results with those of the most used standard anterior approach. Several randomized controlled trials, systematic reviews and meta-analyses demonstrated an important advantage relative to standard anterior RARP in terms of early urinary continence recovery, with comparable perioperative and long-term oncological outcomes. Several surgeons are concerned regarding RS-RARP because it appears to increase the risk of positive surgical margins (PSMs). However, this statement is based on low-certainty evidence. Indeed, the available studies compared the results of surgeons who had an initial experience with posterior RARP with those who had a solid experience with anterior RARP. Recent evidence strongly suggests that RS-RARP is feasible and safe not only in low- and intermediate-risk prostate cancer patient but also in challenging scenario such as high-risk setting, salvage prostatectomy and after transurethral resection of the prostate.

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“…Similarly, also selecting the most challenging scenarios (high-risk patients with bulky BPH or after BPH surgery), urinary continence remains a plus of the approach [44,45].…”

Section: Special Situations and Atypical Advantagesmentioning

confidence: 99%

“…In order to overcome the lack of data on RS-RARP after previous BPH surgery, a recent report evaluated 1386 RS-RARP, of those 7% ( n = 99) had a history of previous TURP [44]. The latter have worse immediate (i.e., 40 vs. 67%) and 12-month continence recovery (68 vs. 94%).…”

Section: Special Situations and Atypical Advantagesmentioning

confidence: 99%

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

Galfano

Secco

Olivero

et al. 2023

Current Opinion in Urology

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Purpose of reviewObjective of our work is to provide an update of the state of the art concerning Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and to give a possible vision on the future developments of this new approach.Recent findingsA nonsystematic literature review has been conducted, finding 27 comparative studies and 24 reviews published up to April 15, 2023. Most of these studies confirm the advantages of RS-RARP relative to standard RARP mainly on early continence recovery. Conversely, discordant findings are reported for the benefit of RS-RARP on late continence recovery. Uncertainty is still present on the impact on positive surgical margins (PSMs), but this statement is based on low level of evidence. Several data concerning the learning curve have shown the safety of RS-RARP, but the need of adequate tutoring. Recent studies also confirmed the feasibility of RS-RARP in the setting of high-risk prostate cancer (PCa), large prostate volume, patients with an history of benign prostatic hyperplasia surgery and patients with a transplanted kidney. Atypical advantages can be also seen in the reduction of risk of postoperative inguinal hernias and in case of concomitant rectal resection.SummaryRetzius-sparing RARP has been confirmed to be one of the standard approaches for the treatment of PCa, with well documented advantages and uncertainty on PSMs.

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Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes

Cited by 11 publications

References 32 publications

A Comprehensive Overview of Intraoperative Complications during Retzius-Sparing Robot-Assisted Radical Prostatectomy: Single Series from High-Volume Center

A Comprehensive Overview of Intraoperative Complications during Retzius-Sparing Robot-Assisted Radical Prostatectomy: Single Series from High-Volume Center

Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

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