Robotic-assisted perineal versus transperitoneal radical prostatectomy: A matched-pair analysis

Abstract

Objective: We compared the outcomes of robotic-assisted radical perineal prostatectomy (r-PRP) versus robotic-assisted transperitoneal laparoscopic radical prostatectomy (RARP). Material and methods:Between November 2016 and September 2017 in our center, 40 patients underwent r-PRP, and 40 patients underwent RARP. All patients also underwent multiparametric magnetic resonance imaging (mpMRI) to exclude the cases with locally advanced disease. Patients with localized prostate cancer (C-T2N0M0) were included in the study. The exclusion criteria were contraindications for undergoing robotic radical prostatectomy; the Gleason score ≥4+3; extracapsular extension proven on biopsy or suspected on mpMRI; clinical stage ≥T2c; required pelvic lymph dissection according to Partin's normogram; previous radiation therapy; hormonal therapy; any previous prostatic, urethral, or bladder neck surgery; and preoperative urinary incontinence or erectile dysfunction. Patients were placed in the exaggerated lithotomy position with 15° Trendelenburg for r-PRP and 40° Trendelenburg for RARP. Results:The mean age for the r-PRP and RARP groups were 61.2 (46-73) and 62.2 (50-75) years, respectively. The mean body mass index was significantly higher in the r-PRP group (p= 0.02). The mean procedure duration time was 169.4 (100-255) minutes for the r-PRP group and 173.1 (130-210) minutes for the RARP group. The mean console time and anastomosis time were significantly lower for the r-PRP group. The mean estimated blood loss was significantly lower for the r-PRP group (p= 0.002). Immediate continence rates in the r-PRP and RARP groups following the urethral catheter removal were 42% and 35% (p= 0.30), respectively. Continence rates increased to 94.2% in the r-PRP and 72% in RARP (p= 0.001) group at the 6 th month, and to 95% in the r-PRP and 85.2% in RARP (p= 0.02) group at the 9th month follow-up period. According to the International Index of Erectile Function-5 (IIEF-5), the erectile function rates at the 3-, 6-, and 9-month follow-up in the r-PRP group were 44%, 66%, and 75%, respectively. The rates in the RARP group at the 3-, 6-, and 9-month follow-up were 25%, 42%, and 66% (p= 0.001), respectively. Conclusion:In our experience, r-PRP has acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results compared to RARP.

Robotic Perineal Radical Prostatectomy: Initial Experience with the da Vinci Si Robotic System

“…The concept of robotic PRP (RPRP) was first reported by Kaouk et al [5] and was deemed a safe and feasible procedure. Tuğcu et al [6] reported perineal access for pelvic lymph node dissection (PLND), and a retrospective matched analysis from the same institution further investigated the potential superiority of RPRP due to the reduced operative time and blood loss, the shorter postoperative recovery time, and better short-term quality-of life outcomes [7]. However, the surgical skill required for RPRP is still challenging, especially regarding the relatively unfamiliar anatomy of the pelvic floor.…”

Single-Port Robot-Assisted Perineal Radical Prostatectomy: Our Initial Experience

“…The application of robot system in RPRP is helpful to overcome the above obstacles in conventional RPP [13] . RPRP provides a more minimally invasive approach, providing more convenience for surgeons and auxiliary surgeons [14] . We recommend the use of a 30 °endoscope, which faces up throughout the operation to minimize collisions with external robots.…”

Retzius-sparing robot-assisted radical prostatectomy: initial experience and surgical technique

“…Первым этапом при таких операциях выполняется открытая диссекция диафрагмы таза, после чего начинается роботический этап, в ходе которого удаляется предстательная железа и накладывается анастомоз. V. Tugcu et al в сравнительном исследовании традиционного и промежностного доступов продемонстрировали преимущество второго в длительности операции и частоте восстановления нормального удержания мочи [11].…”