Asian journal of endoscopic surgery · 2026
Retzius-Sparing Laparoscopic Radical Prostatectomy in A Nonrobotic Setting: A 30-Case Implementation Series With Minimum 18-Month Follow-Up.
СтатьяНазвание и аннотация: Перевод в очереди
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Fernandez-Alberti Joaquin, Ernst Glenda, Scolari Guillermo, Lopez Alex Villaalta, Panzardi Nicolas, Featherston Marcelo, Martinez Pablo Miguel
Аннотация
INTRODUCTION: Published experience with Retzius-sparing laparoscopic radical prostatectomy remains limited, particularly in nonrobotic settings. We aimed to describe procedural completion, perioperative safety, and descriptive functional and early oncologic outcomes in an initial 30-case implementation series with minimum 18-month follow-up.
METHODS: We conducted a retrospective single-center study of 30 consecutive men with localized prostate cancer who underwent Retzius-sparing laparoscopic radical prostatectomy between October 2022 and November 2023. All procedures were performed by a single experienced laparoscopic surgeon. The co-primary endpoints were procedural completion pattern and perioperative safety within 30 days. Secondary endpoints included positive surgical margins, social urinary continence, erectile function, and early oncologic outcomes.
RESULTS: Twenty-six of 30 procedures (86.7%) were completed entirely through the posterior Retzius-sparing approach, whereas four cases (13.3%) required limited prevesical release for hybrid anterior completion; no open conversions occurred. Three of these four hybrid completions occurred within the first tertile of the series. Mean operative time was 224.6 min and mean estimated blood loss was 307.7 mL. Major complications occurred in four patients (13.3%), including one distal ureteral injury requiring laparoscopic reoperation and ureteral reimplantation. Positive surgical margins were found in seven patients (23.3%). Social continence rates using a 0-1 safety pad/day definition were 23.3% at catheter removal, 36.7% at 1 month, 60.0% at 3 months, 83.3% at 6 months, and 93.3% at both 12 and 18 months. Strict 0-pad continence was not systematically recorded. Persistent PSA and biochemical recurrence were observed in 6.7% and 20.0% of patients, respectively, during available follow-up.
CONCLUSION: Retzius-sparing laparoscopic radical prostatectomy was technically feasible in selected patients in a nonrobotic setting, with full posterior completion achieved in most cases and hybrid anterior completion required in a minority during early adoption. Functional and oncologic outcomes should be interpreted cautiously given the retrospective single-arm design, small cohort, complication profile, heterogeneous mpMRI use, and limited follow-up.
METHODS: We conducted a retrospective single-center study of 30 consecutive men with localized prostate cancer who underwent Retzius-sparing laparoscopic radical prostatectomy between October 2022 and November 2023. All procedures were performed by a single experienced laparoscopic surgeon. The co-primary endpoints were procedural completion pattern and perioperative safety within 30 days. Secondary endpoints included positive surgical margins, social urinary continence, erectile function, and early oncologic outcomes.
RESULTS: Twenty-six of 30 procedures (86.7%) were completed entirely through the posterior Retzius-sparing approach, whereas four cases (13.3%) required limited prevesical release for hybrid anterior completion; no open conversions occurred. Three of these four hybrid completions occurred within the first tertile of the series. Mean operative time was 224.6 min and mean estimated blood loss was 307.7 mL. Major complications occurred in four patients (13.3%), including one distal ureteral injury requiring laparoscopic reoperation and ureteral reimplantation. Positive surgical margins were found in seven patients (23.3%). Social continence rates using a 0-1 safety pad/day definition were 23.3% at catheter removal, 36.7% at 1 month, 60.0% at 3 months, 83.3% at 6 months, and 93.3% at both 12 and 18 months. Strict 0-pad continence was not systematically recorded. Persistent PSA and biochemical recurrence were observed in 6.7% and 20.0% of patients, respectively, during available follow-up.
CONCLUSION: Retzius-sparing laparoscopic radical prostatectomy was technically feasible in selected patients in a nonrobotic setting, with full posterior completion achieved in most cases and hybrid anterior completion required in a minority during early adoption. Functional and oncologic outcomes should be interpreted cautiously given the retrospective single-arm design, small cohort, complication profile, heterogeneous mpMRI use, and limited follow-up.