V1275: Important Technical Modifications to Improve Outcomes in Robotic Assisted Radical Prostatectomy - Lessons learned After 5.000 cases
VideoIntroduction and Objectives
We report the lessons learnt after 5000 cases of robot assisted radical prostatectomy, done by a single surgeon after an extended learning curve, showing key modifications applied to improve outcomes.
The present study is a combination of (1) a literature review, (2) presentation of a single surgeon experience of 5000 patients undergoing robotic assisted radical prostatectomy between 2008 and 2012 and (3) a compilation of technical implementations for in each step of the procedure.
Regarding cancer control, which includes the PSM and BCR, we show strategies to reduce margin rates. In early return to continence, we report results of periurethral suspension stitch, bladder neck plication and posterior reconstruction of the rhabdosphincter.
To improve potency outcomes, we present the key principles of our nerve sparing technique together with our anatomical approach to nerve spearing. Results obtained with the application of these lessons have led to continuous improvement of peri and postoperative outcomes.
Robotic prostatectomy is still in evolution. Technical modifications resulting in improved oncological and functional outcomes are the result of increasing surgical experience and procedure understanding.