Conformal Intrafascial Robot-Assisted Laparoscopic Radical Prostatectomy via the Anterior Approach: Optimizing Functional Outcomes.

Abstract

Propose the conformal intrafascial robot-assisted laparoscopic radical prostatectomy (RARP) via the anterior approach as a reproducible way to maximally preserve neurovascular bundle (NVB) and improve functional outcomes. This is an IDEAL stage 2a-2b feasibility prospective cohort with pre-defined outcomes metrics, which include 50 consecutive patients undergoing RARP performed by a single surgeon (Y.C.G.). The bladder neck is incised medially close to the base of prostate by improved HOOD-sparing technology. The posterior prostatic capsule is marked, whilst tiny blood vessels are controlled with monopolar cauterization, and clips are avoided. The NVB is released antegradely towards the prostatic apex. Potency was defined as a Sexual Health Inventory for Men score  ≥ 17; incontinence was defined as daily use of  > 1 pads. The median age of the patients was 63 years. The mean console time was 75 min; 100% had bilateral nerve sparing; 96% were pT2, and 4% were pT3. Overall positive surgical margins rate was 16% (8/50). Two patients (4%) received adjuvant or salvage radiotherapy. At 12 months after surgery, biochemical recurrence occurred in one patient (2%). Immediate continence rate was 62% (31/50), and 100% were continent at 1 year. Thirty-three patients(66%) were potent 3 months postoperatively, while 43 patients (86%) were potent 1 year after surgery. Trifecta were achieved for 43 (86%) patients at 12 months. Conformal intrafascial RARP via the anterior approach is a reproducible way to minimize NVB injury, thereby achieving promising oncological and functional outcomes in our preliminary cohort.