Modified apical dissection improves early continence in robot-assisted laparoscopic radical prostatectomy: Comparative study between modified apical dissection and anterior suspension stitch

Modified apical dissection during robot-assisted laparoscopic radical prostatectomy: a systematic review and meta-analysis

Robot-assisted laparoscopic radical prostatectomy (RALP) has improved patient recovery, but achieving optimal functional outcomes remains a challenge, especially early urinary continence. The Modified Apical Dissection (MAD) technique has been suggested to improve early continence compared to conventional RALP. A comprehensive search of PubMed, Embase, and Cochrane Central databases was conducted to identify studies on MAD from inception to March 2024. The risk of bias was evaluated using the ROBINS-I tool. Primary outcomes assessed included urinary continence, positive surgical margin rate, biochemical recurrence rates, and complication rates. Out of 789 studies screened initially, we selected 8 studies that met our inclusion criteria. Our analysis showed that patients who underwent the MAD technique had a significantly higher likelihood of achieving early urinary continence compared to those undergoing conventional RALP at the initial follow-up (Odds Ratio [OR] = 4.0, 95% CI = 1.87-8.57). This advantage continued at 1 month (OR = 5.44, 95% CI = 2.98-9.92), 3 months (OR = 5.36, 95% CI = 2.26-12.71), and 6 months (OR = 5.18, 95% CI = 1.51-17.75), though no significant difference was noted at 12 months. There were no significant differences in positive surgical margin rate or biochemical recurrence rate between MAD and conventional RALP. The overall complication rate was 10.9% (95% CI = 8.10-14.06), with most complications being classified as minor (Clavien-Dindo I-II). In summary, our meta-analysis suggests that the MAD technique may lead to earlier recovery of urinary continence without compromising oncologic outcomes in patients undergoing RALP. While there are published studies on the outcomes of MAD, only a few have the appropriate design with a comparison group needed for meta-analysis and discussing various endpoints. More randomized controlled trials are necessary, but the current literature still lacks retrospective studies with comparison groups.

Application of anatomic reconstruction technique for periurethral structure in robotic assisted laparoscopic radical prostatectomy

OBJECTIVE

To investigate the outcome of patients underwent anatomic periurethral reconstruction during robotic assisted laparoscopic radical prostatectomy (RARP).

MATERIALS AND METHODS

During August 2016 to May 2018, periurethral structure anatomic reconstruction was performed during RARP in 58 consecutive patients. The control group consists of another 50 patients had no reconstruction procedure during RARP. Perioperative data of these patients were collected retrospectively, including operation time, anastomosis time, intraoperative blood loss, duration of indwelling catheter, length of hospital stay, complications, postoperative pathology, and continence outcome at 1,3,6 and 12 months.

RESULTS

All cases were successfully performed without conversion to open or laparoscopic surgery. There were no major intraoperative or postoperative complications.The percentage of patients maintain continence in the reconstruction group versus non-reconstruction group: At 1 month 84.5% (49/58)versus 70.0% (35/50), at 3 months 89.7% (52/58)versus 78.0% (39/50), at 6 months 91.3% (53/58)versus 86.0% (43/50) and 1 year after surgery 100.0% (58/58)versus 96.0% (48/50). Reconstruction group showed better continence outcome in 1 and 3 months (P<0.05). There is no statistical differences in 6 month and 1 year.

CONCLUSION

Anatomic reconstruction of periurethral structure during RARP is safe and feasible with reduced duration of indwelling catheter and better continence outcome.