Marcio Covas Moschovas1, Seetharam Bhat1, Fikret Fatih Onol2, Travis Rogers1, Shannon Roof1, Elio Mazzone3, Alexandre Mottrie4, Vipul Patel1. 1. Florida Hospital Global Robotics Institute, Celebration, FL, USA. 2. Florida Hospital Global Robotics Institute, Celebration, FL, USA. Electronic address: ffonol@yahoo.com. 3. ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
Abstract
BACKGROUND: Early recovery of continence and potency after robotic-assisted laparoscopic prostatectomy (RALP) still remains a challenge. OBJECTIVE: To assess the effect of our modified apical dissection and lateral prostatic fascia preservation (mod-RALP) technique on early functional outcomes. DESIGN, SETTING, AND PARTICIPANTS: Among 2168 patients who underwent RALP between 2017 and 2019, 104 received a mod-RALP, and for the purposes of this study they were propensity score (PS) matched with a control group of conventional RALP cases based on preoperative and histological characteristics. SURGICAL PROCEDURE: In the mod-RALP technique, significant dissection of the apical complex was avoided with maximized preservation of periurethral tissue around the urethral stump. Nerve sparing was also modified with intrafascial dissection inside of the lateral fascia, leaving the lateral tissue including the neurovascular bundle (NVB) untouched and covered. MEASUREMENTS: The mod-RALP and conventional RALP groups were compared for continence and potency recovery at 1 and 6 wk postoperatively, as well as at 3, 6, and 12 mo. Kaplan-Meier curves and multivariate Cox regression models were used to identify survival estimations and their predictors. RESULTS AND LIMITATIONS: The mod-RALP technique resulted in faster continence (mean 46 vs 70 d) and potency (mean 74 vs 118 d, p < 0.05 for both) recovery. Functional recovery rates at postoperative follow-up were significantly higher in the mod-RALP group at all time points within the first 6 mo following surgery. Multivariate analyses revealed age, baseline functional status, surgical technique, and lymph node dissection as independent predictors of early functional recovery. This study is limited by its retrospective design and small size of the study groups. CONCLUSIONS: Our results with a modified technique intended to better preserve the apical complex and NVBs suggest earlier recovery of urinary continence and sexual function. These results should be tested with future randomized studies. PATIENT SUMMARY: We report a modified approach to apical dissection and lateral prostatic fascia preservation in robotic-assisted laparoscopic prostatectomy that resulted in earlier continence and potency recovery as compared with our conventional technique.
BACKGROUND: Early recovery of continence and potency after robotic-assisted laparoscopic prostatectomy (RALP) still remains a challenge. OBJECTIVE: To assess the effect of our modified apical dissection and lateral prostatic fascia preservation (mod-RALP) technique on early functional outcomes. DESIGN, SETTING, AND PARTICIPANTS: Among 2168 patients who underwent RALP between 2017 and 2019, 104 received a mod-RALP, and for the purposes of this study they were propensity score (PS) matched with a control group of conventional RALP cases based on preoperative and histological characteristics. SURGICAL PROCEDURE: In the mod-RALP technique, significant dissection of the apical complex was avoided with maximized preservation of periurethral tissue around the urethral stump. Nerve sparing was also modified with intrafascial dissection inside of the lateral fascia, leaving the lateral tissue including the neurovascular bundle (NVB) untouched and covered. MEASUREMENTS: The mod-RALP and conventional RALP groups were compared for continence and potency recovery at 1 and 6 wk postoperatively, as well as at 3, 6, and 12 mo. Kaplan-Meier curves and multivariate Cox regression models were used to identify survival estimations and their predictors. RESULTS AND LIMITATIONS: The mod-RALP technique resulted in faster continence (mean 46 vs 70 d) and potency (mean 74 vs 118 d, p < 0.05 for both) recovery. Functional recovery rates at postoperative follow-up were significantly higher in the mod-RALP group at all time points within the first 6 mo following surgery. Multivariate analyses revealed age, baseline functional status, surgical technique, and lymph node dissection as independent predictors of early functional recovery. This study is limited by its retrospective design and small size of the study groups. CONCLUSIONS: Our results with a modified technique intended to better preserve the apical complex and NVBs suggest earlier recovery of urinary continence and sexual function. These results should be tested with future randomized studies. PATIENT SUMMARY: We report a modified approach to apical dissection and lateral prostatic fascia preservation in robotic-assisted laparoscopic prostatectomy that resulted in earlier continence and potency recovery as compared with our conventional technique.
Authors: Jim Adshead; Nikhil Vasdev; Jonathan Noël; Neil H Spencer; Siya Lodia; Seiver Karim; Surina Taneja; Darius Moghanchizadeh; Arvind Nayak; Ashwin Tamhankar; Seema Angra; Rajiv Swamy; Samita Agarwal; Ashish Narula; Tim Lane Journal: J Robot Surg Date: 2021-10-30
Authors: Spyridon P Basourakos; Keith Kowalczyk; Marcio Covas Moschovas; Vanessa Dudley; Andrew J Hung; Jonathan E Shoag; Vipul Patel; Jim C Hu Journal: J Endourol Date: 2021-11 Impact factor: 2.942