Intrafascial nerve-sparing radical prostatectomy with a laparoscopic robot-assisted extraperitoneal approach: early oncological and functional results.
OBJECTIVE
We investigated whether an intrafascial approach to prostatectomy would provide significantly improved outcomes compared with retropubic and laparoscopic approaches. We performed 50 radical prostatectomies with an intrafascial, nerve-sparing, laparoscopic, robot-assisted extraperitoneal approach.


METHODS
From December 2007 to June 2008, 50 consecutive patients underwent nerve sparing surgery using the intrafascial technique with robotic assistance. All surgeries were performed by the same senior urologist. Patient characteristics and perioperative data were collected prospectively. Oncological outcomes were assessed by pathological examination and postoperative prostate-specific antigen levels. Functional outcomes, including continence, potency, and quality of life, were assessed from patient questionnaires.


RESULTS
The mean operative time was 127 minutes (range: 80-205), the mean hospital stay was 4.2 days (range: 2-9), and the mean catheterization time was 7.8 days (range: 4-11). No perioperative complications occurred. One patient required a transfusion at the postoperative stage. The overall positive surgical margin rate was 12%; adjusted by tumor, nodes, and metastasis stage, it was 9.5% in pT2 and 17% in pT3 disease. At the 1-month follow-up, 66% of the patients were continent (no pad), 12% presented a minimal stress urinary incontinence (1 pad), and 22% required >1 pad(s) per day. Further, 60% of patients exhibited potency (erection sufficient for intercourse: 30% without the use of phosphodiesterase 5 inhibitors, 30% required a phosphodiesterase 5 inhibitor) and the remaining 40% required prostaglandin injections.


CONCLUSIONS
An intrafascial approach with robotic assistance provided satisfactory early functional results with respect to postoperative continence and potency. Long-term oncological results remain to be assessed.
Xylinas
Evanguelos
E
Department of Urology, Henri Mondor Hospital, Créteil, France.
Ploussard
Guillaume
G
Salomon
Laurent
L
Paul
Alexandre
A
Gillion
Norman
N
Laet
Kevin De
KD
Vordos
Dimitri
D
Hoznek
Andras
A
Abbou
Clément-Claude
CC
de la Taille
Alexandre
A
D000368:Aged; D004210:Dissection; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology; D019990:Perioperative Care; D010537:Peritoneum / Q000601:surgery*; D011467:Prostate / Q000294:innervation* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011788:Quality of Life; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery