Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy on postoperative hepatic and renal function

Nerve-sparing techniques in robot-assisted radical prostatectomy - anatomical approach

INTRODUCTION

Nerve-sparing (NS) techniques in robot-assisted radical prostatectomy (RARP) are foundational to preserving sexual function and urinary continence in prostate cancer (PCa) patients.

AREAS COVERED

This article aims to classify nerve-sparing (NS) techniques in RARP based on an anatomical approach to the prostate. We have identified three main NS approaches in RARP: anterior, lateral, and posterior. The anterior approach, which involves early retrograde nerve release, improves early potency rates. The lateral approach, using hybrid techniques and extra-fascial dissection, provides clear nerve visualization and reduces nerve injuries, enhancing continence and potency recovery. The posterior approach, particularly the hood technique, effectively preserves periurethral structures, leading to high continence rates within a year post-surgery. The posterior approach effectively balances nerve preservation with cancer control.

EXPERT OPINION

Re-classifying NS techniques in RARP based on an anatomical approach optimizes patient outcomes and the surgeon choice. A personalized approach to those techniques improves functional recovery and maintains oncological safety in PCa surgery. Further studies are needed to confirm those findings and refine the selection criteria.

State of art of robotic prostatectomy: the way we do it in Catalonia, Spain

INTRODUCTION AND OBJECTIVE

Robotic-assisted laparoscopic prostatectomy (PLAR) seems to improve functional outcomes, however there is not a consensus of a standard procedure. The aim of this study was to identify the PLAR "state of art" in Catalonia, Spain.

MATERIAL AND METHODS

This was a cross-sectional survey-based study conducted among urologists across Catalonia, Spain. The survey was distributed through online platforms and the professional urology society. All statistical analyses were performed using Stata software, v20.

RESULTS

59 urologists completed the survey, revealing PLAR as the most commonly used technique (79.7%). Most urologist (70%) create the pneumoperitoneum using a controlled incision with direct access and 78.3% use the Airseal technology. The intraperitoneal approach is performed in >90% of cases. Endopelvic fascia preservation is not routinely performed. 34.5% of the survey not perform the dorsal vein complex suture. All preserves the bladder neck when oncologically safe. Nerve-vascular bundles bleeding control is performed using standard coagulation or suturing. 34% performed posterior reconstruction. Only use hemostatic devices when evident bleeding and 70% does not routinely left a drainage. Multivariable analysis showed that center volume had a significant independent association with dorsal venous complex suturing (OR 0.073, 95%CI 0.07-0.826), nerve-vascular bundles suturing hemostasis (OR 11.67, 95%CI 1.07-127.60) and endopelvic fascia preservation (OR 13.64, 95%CI 1.087-201.27), but there was no correlation with time the bladder catheter or days hospitalized.

CONCLUSIONS

The study provides an overview of the state of PLAR in Catalonia, Spain, showing significant variability and reflecting a commitment to advancing surgical technology and patient care.