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

Abstract

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.

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

“…Retzius-sparing robot-assisted radical prostatectomy (RS-RARP), after being proposed more than a decade ago [3], has rapidly gained success worldwide [4] due to clinically improved continence recovery relative to the standard approach, as demonstrated in randomized clinical trials and metanalyses [5][6][7]. Nevertheless, several authors claim that RS-RARP is a complex technique with a prolonged learning curve that could lead to adverse events [8].…”

Special Issue: “Latest Advances on Urinary Incontinence”

“…UI is one of the most frequent complications after robot-assisted radical prostatectomy (RARP) [12,13]. RARP can be performed with several techniques and different robotic platforms, constant efforts are made to improve functional outcomes [14][15][16]. Gacci et al [17] published a review with the latest evidence on UI after RARP.…”