V11-10: Anterior Retzius Sparing Technique for Robotic Assisted Radical Prostatectomy
In addition to the primary oncological aim of complete excision of cancer, post operative urinary continence remains a major element in the surgical management of patients with localised prostate cancer that Urologists continue to improve on. In the last decade, a new technique named Retzius Sparing (posterior approach), when compared to the standard (anterior approach) Robotic Assisted Radical Prostatectomy (RARP) has shown superior continence recovery. The technique of this posterior approach is technically challenging, especially when it relates to training Residents and Fellows. Our Unit performs a hybrid approach whereby a fusion of both techniques mentioned is employed. This is known as the Anterior Retzius Sparing (ARS) Technique for RARP.
In the posterior retzius sparing approach, preservation of all anterior structures such as the endopelvic fascia, dorsal venous complex (DVC) and pubovesical ligaments is performed. With our new ARS approach, we preserve the urachus and therefore the anatomical bladder position. The operation is continued in the standard anterior approach, except the dorsal venous complex (DVC) and urethral complex is dissected off the anterior side of the prostate. The non expert Urologists can perform Robotic suturing of the DVC, Rocco suture and the vesicourethral anastamosis in a familiar and training appropriate setting. Following the vesicourethral anastomosis, a 16 Foley 2-way catheter is inserted into the bladder suprapubically and left for 7 days. A urethral catheter is inserted also and removed on discharge, the following post operative day. Following our Institutional review board approval, we evaluated patients with localised prostate cancer that underwent RARP from 2017-2018 by a single surgeon. We compared the first 120 cases of ARS technique with 120 cases of the standard (anterior approach) RARP.
Immediate continence was observed in 75% of cases from the anterior retzius group compared to 25% from the standard approach. Our initial results show that ARS translates to early return to full continence compared to the standard non retzius sparing approach.
It is our conclusion that the ARS technique, compared to posterior retzius spare, has an easier learning curve, with less technical challenges as depicted in the surgical video. This is beneficial for the training of Residents and Fellows as is reflected by the familiar steps and anatomy of the conventional RARP. Importantly, it allows the patient the advantage of a retzius spare.