Safety and Outcomes of Intraoperative Ventriculoperitoneal Shunt Clamping During Robotic-assisted Radical Prostatectomy: Retrospective Cohort Analysis.

BACKGROUND/AIM: This study aimed to assess the safety and outcomes of intraoperative ventriculoperitoneal (VP) shunt clamping during robotic-assisted radical prostatectomy (RaRP) in patients with VP shunts.

PATIENTS AND

METHODS

A retrospective analysis of nine patients with VP shunts who underwent RaRP between February 2016 and October 2024 was conducted. Data on preoperative prostate-specific antigen (PSA) levels, surgical margins, complications, and follow-up durations were collected. Patients were stratified into subgroups based on PSA levels (≤10 vs. >10 ng/ml), operative time (<200 vs. ≥200 min), and estimated blood loss (<150 vs. ≥150 ml). Outcomes were analyzed using descriptive statistics, focusing on PSA trends, biochemical recurrence, and VP shunt functionality.

RESULTS

All procedures were completed without intraoperative or VP shunt-related complications. The median operative time was 180 min (range=180-330 min), and the median estimated blood loss was 170 ml (range=50-700 ml). Most patients showed significant PSA suppression, with a median PSA of <0.008 ng/ml at one year. Patients with initial PSA levels >10 ng/ml had greater variability in PSA trends, including persistent elevation or biochemical recurrence, whereas those with PSA levels ≤10 ng/ml had stable outcomes. No differences in oncological outcomes were noted based on operative time or blood loss. Median follow-up was 54 months (range=2-105 months).

CONCLUSION

VP shunt clamping during RaRP is safe and effective, with favorable surgical and oncological outcomes and preserved shunt functionality. Larger studies are needed to confirm these findings and establish standardized protocols.