Investig Clin Urol.  2020 Jan;61(1):1-10. 10.4111/icu.2020.61.1.1.

Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?

Affiliations
  • 1Department of Urology, Korea University College of Medicine, Seoul, Korea.
  • 2Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida School of Medicine, Orlando, FL, USA. vipul.patel.md@flhosp.org

Abstract

Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared).

Keyword

Prostate; Prostatectomy; Prostatic neoplasms; Robotics

MeSH Terms

Fascia
Humans
Male
Nerve Tissue
Nomograms
Prostate
Prostatectomy*
Prostatic Neoplasms
Reproductive Health
Robotics
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