Outcomes of lateral approach in robot-assisted radical prostatectomy: insights from a single-surgeon experience

Abstract

In the era of robotic prostate surgery, various techniques have been developed to improve functional outcomes. Urinary continence has shown satisfactory results, but the preservation of lateral nerves to the periprostatic capsule is only achievable by sparing the pubovesical complex. This study aims to present the first cases of lateral-approach robot-assisted radical prostatectomy (LRRP) performed by a novice surgeon. We conducted a retrospective analysis of 70 prostate cancer patients who underwent LRRP between October 2019 and September 2021, analyzing the perioperative and functional outcomes. The median operative time and intraoperative blood loss were 102 (92-108) minutes and 150 (130-180) mL, respectively. Five minor postoperative complications were reported, and the median hospital stay was 2 (1-2) days. Eleven positive surgical margins occurred. Potency and urinary continence recovery were achieved in 59 (84%) and 66 (94%) patients, respectively, 12 months after surgery. Our analysis shows that LRRP is a safe and effective procedure for prostate cancer surgery. Continence and potency recovery required a short learning curve, with an acceptable recovery rate even in the initial cases.

Keywords: Erectile function; Lateral approach; Prostate cancer; Robot-assisted radical prostatectomy; Urinary continence.

Fig. 1

The Location for Port Placement in Lateral Approach in Robot-assisted Radical Prostatectomy

Fig. 2

Surgical steps of lateral-approach robot-assisted radical prostatectomy: a Peritoneum incision and access to Retzius space; b Right intrafascial plane development; c Bladder neck incision; d Left posterior lateral dissection of the prostate; e Urethra section; f vesicourethral anastomosis