Should we shift to Retzius-preserving robotic assisted laparoscopic radical prostatectomy?

Purpose: Some studies reported a comparable oncological outcome and better early continence rate of Retzius-preserving robotic assisted laparoscopic radical prostatectomy (RALP). We want to compare the early perioperative and continence outcome. And we are also eager to know if the learning curve of Retzius-preserving surgery would compromise the outcome or not?

Materials and Methods: We selected patient with organ-confined prostate cancer (≤ cT2c), PSA ≤ 40, Gleason score of biopsy ≤ 8, prostate volume ≤ 50 ml and BMI < 35. We design a case control matching study with 20 cases of each Retzius-preserving RALP and conventional RALP group. Postoperative parameter and early continence result was compared.

Results: From Febuary, 2015 to Febuary, 2016, total 84 cases of RALP were performed in VGHTC. Twenty of them underwent Retzius-preserving RALP. There is no statistical difference of preoperative characteristics. There were no significant differences in estimated blood loss, mean length of hospital stay, intra- and postoperative complication rates, pathological stage of disease, Gleason scores, tumour volumes and positive surgical margins between the conventional RALP and Retzius-sparing RALP groups. However, console time, Vesicourethral anastomosis time were longer for Retzius-sparing RALP. There is no significant difference of early continence at 4 weeks between two groups.

Conclusion: Based on the early result of this study, Retzius-preserving RALP is a feasible and safe treatment choice for localized prostate cancer. Both console time and anastomosis time are favoring to conventional RALP.