Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes

Abstract

Objectives To describe in detail the techniques for transvesical robot‐assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer. Patients and Methods Thirty‐five patients with localized prostate cancer were enrolled for transvesical RARP. The patients' preoperative data (mean ± sd age 63.4 ± 8.1 years, body mass index 28.6 ± 5.3 kg/m 2 , total prostate‐specific antigen 10.8 ± 4.9 ng/mL and prostate volume 30.6 ± 14.4 mL, and median [interquartile range {IQR}] biopsy Gleason score 6 [6–7], and International Index of Erectile Function [IIEF]‐5 score 18 [16–20]) were collected. Preoperative assessment revealed 28 cases of cT2a and seven cases of cT2b disease. All patients were continent preoperatively (defined as no pad required or one dry pad per day as a precaution). Surgical results and peri‐operative complications were assessed. All patients were followed up for at least 12 months postoperatively. Results The mean operating time was 150 ± 35 min. Estimated blood loss was 100 ± 45 mL. Urinary infection was noted in one patient and managed with levofloxacin. Another patient complained of nocturia on postoperative day 14, which was relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. Thirty‐two patients achieved immediate urinary continence, with three patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, nine pT2b cases and two pT2c cases (median [IQR] Gleason score 6 [6–7]). Positive surgical margins were found in four patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies were performed preoperatively and 6 months after surgery: median (IQR) maximum urinary flow 12.2 (10.2–14.9) vs 13.7 (10.1–15.0) mL/s; bladder capacity 385.3 (351.3–410.2) vs 370.2 (330.1–395.4) mL; and voiding phase detrusor contractility 38.5 (27.8–42.3) vs 35.6 (28.3–41.3) mmH 2 O, respectively. During a minimum of 12 months of follow‐up, no biochemical recurrence was noted in any patient. The median (IQR) IIEF‐5 score was 17 (16–19). Conclusions The transvesical approach is a valid alternative to RARP in selected patients, providing promising postoperative urinary continence. Long‐term functional and oncological results require further investigation.

Comprehensive approach for preserving cavernous nerves and erectile function after radical prostatectomy in the era of robotic surgery

“…25 Thereafter, Zhou et al reported the outcome of 35 consecutive patients who underwent transvesical RARP in a clinical setting. 26 Although an 8-cm longitudinal incision of the bladder was required, retropubic structures were preserved to the same level as RS-RARP. Bladder function evaluated 6 months after surgery was not significantly different from baseline bladder function.…”

“…Thereafter, Zhou et al . reported the outcome of 35 consecutive patients who underwent transvesical RARP in a clinical setting 26 . Although an 8‐cm longitudinal incision of the bladder was required, retropubic structures were preserved to the same level as RS‐RARP.…”

Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up

“…P-RARP was performed by two highly experienced surgeons (Wang GX and Fu B) in compliance with the techniques established by Bocciardi et al (11), while T-RARP was completed by Wang GX since January 2018 following the surgical steps described in our published study (14). These two surgeons (Wang GX and Fu B)had received standardized training in robotic surgery and performed more than 300 robot-assisted radical prostatectomies via the anterior or posterior approaches by the time that the transvesical approach was applied on the first patient.…”

“…Given the absence of disruption to Retzius' space by posterior and transvesical approaches, we hypothesized that transvesical RARP (T-RARP) could yield similar functional outcomes to posterior RARP (P-RARP) in well-selected patients. Our team firstly applied this approach on such patients harboring low-risk localized prostate cancer with several appropriate modifications made and detailedly described the whole process for T-RARP on a multi-port basis with the da-Vinci Si/Xi system (14).…”

Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis

“…Similar to the posterior RARP, T-RARP obviated any disruptions to the Retzius space, which is of great importance to optimum postoperative continence. Our team firstly performed T-RARP, another approach to Retzius-sparing RARP, on well-selected patients with localized PCa and detailedly reported its whole procedure on a multi-port basis (10).…”