The Comparison of Conventional and Retzius-Sparing Robot-Assisted Radical Prostatectomy for Clinical, Pathological, and Oncological Outcomes

Abstract

Initial description of the surgical technique involves the dissection of the Retzius space after dropping the bladder from the anterior abdominal wall which is now considered as the "conventional" method of robot-assisted radical prostatectomy (cRARP). Retzius-sparing RARP (RsRARP; Bocciardi approach) was initially introduced by Galfano et al. in 2010 and it is one of the most innovative surgical approaches which allows preservation of deep dorsal venous complex and anatomical structures responsible for urinary continence such as urinary sphincter, endopelvic fascia, and puboprostatic ligaments. RsRARP appears to have superior early continence recovery and similar oncologic outcomes when compared to cRARP. Studies of direct comparison of cRARP with RsRARP in the hands of the same surgeon(s) are still limited. In this study we presented our single-center, single-surgeon, long-term experience by comparing cRARP and RsRARP in terms of perioperative clinical, pathological, and oncological outcomes. One of the main emerging findings of this study was a shorter surgical time with RsRARP. RsRARP becomes prominent with a shorter surgery duration and similar complication rates when compared to cRARP in patients with higher ASA class scores even if they had higher cT stages and D'Amico clinical risk group in the preoperative evaluation indicating a safe surgical approach.