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Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases

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Abstract

Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. Over the past 18 years, we have performed 13,000 radical prostatectomies, and our surgical technique has evolved over time. We discuss this evolution and how it has helped us achieve optimal patient outcomes.

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References

  1. Oberlin DT, Flum AS, Lai JD, Meeks JJ (2016) The effect of minimally invasive prostatectomy on practice patterns of American urologists. Urol Oncol 34(6):255.e1–5

    Article  Google Scholar 

  2. Ploussard G (2017) Robotic surgery in urology: facts and reality what are the real advantages of robotic approaches for prostate cancer patients? Curr Opin Urol. https://doi.org/10.1097/MOU.0000000000000470(Epub ahead of print)

    Article  Google Scholar 

  3. Patel VR, Shah KK, Thaly RK, Lavery H (2007) Robotic-assisted laparoscopic radical prostatectomy: the Ohio State University technique. J Robot Surg 1(1):51–59

    Article  Google Scholar 

  4. Patel VR, Palmer KJ, Coughlin G, Samavedi S (2008) Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol 10:2299–2305

    Article  Google Scholar 

  5. Coughlin G, Dangle PP, Palmer KJ, Samevedi S, Patel VR (2009) Athermal early retrograde release of the neurovascular bundle during nerve-sparing robotic-assisted laparoscopic radical prostatectomy. J Robot Surg 3(1):13–17

    Article  Google Scholar 

  6. Lin VC, Coughlin G, Savamedi S, Palmer KJ, Coelho RF, Patel VR (2009) Modified transverse plication for bladder neck reconstruction during robotic-assisted laparoscopic prostatectomy. BJU Int 104(6):878–881

    Article  Google Scholar 

  7. Horstmann M, Horton K, Kurz M, Padevit C, John H (2013) Prospective comparison between the AirSeal® System valve-less Trocar and a standard Versaport™ Plus V2 Trocar in robotic-assisted radical prostatectomy. J Endourol 27(5):579–582

    Article  Google Scholar 

  8. Patel VR, Coelho RF, Palmer KJ, Rocco B (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56(3):472–478

    Article  Google Scholar 

  9. Ko YH, Coelho RF, Sivaraman A, Schatloff O, Chauhan S, Abdul-Muhsin HM, Carrion RJ, Palmer KJ, Cheon J, Patel VR (2013) Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: which is better for achieving early functional recovery? Eur Urol 63(1):169–177

    Article  Google Scholar 

  10. Patel VR, Schatloff O, Chauhan S, Sivaraman A, Valero R, Coelho RF, Rocco B, Palmer KJ, Kameh D (2012) The role of the prostatic vasculature as a landmark for nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61(3):571–576

    Article  Google Scholar 

  11. Schatloff O, Chauhan S, Sivaraman A, Kameh D, Palmer KJ, Patel VR (2012) Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61(4):796–802

    Article  Google Scholar 

  12. Schatloff O, Chauhan S, Kameh D, Valero R, Ko YH, Sivaraman A, Coelho RF, Marquinez J, Palmer KJ, Patel VR (2012) Cavernosal nerve preservation during robot-assisted radical prostatectomy is a graded rather than an all-or-none phenomenon: objective demonstration by assessment of residual nerve tissue on surgical specimens. Urology 79(3):596–600

    Article  Google Scholar 

  13. Kang SG, Schatloff O, Haidar AM, Samavedi S, Palmer KJ, Cheon J, Patel VR (2015) Does surgeon subjective nerve sparing score predict recovery time of erectile function following robot-assisted radical prostatectomy? J Sex Med 12(6):1490–1496

    Article  Google Scholar 

  14. Kumar A, Samavedi S, Mouraviev V, Marquinez J, Patel VR (2017) Innovative application of instant toggling of endoscope in challenging cases during robot-assisted radical prostatectomy using Xi da-Vinci robotic surgical system. Videourology. https://doi.org/10.1089/vid.2016.0043

    Article  Google Scholar 

  15. Patel VR, Samavedi S, Bates AS, Kumar A, Coelho R, Rocco B, Palmer K (2015) Dehydrated human amnion/chorion membrane allograft nerve wrap around the prostatic neurovascular bundle accelerates early return to continence and potency following robot-assisted radical prostatectomy: propensity score-matched analysis. Eur Urol 67(6):977–980

    Article  Google Scholar 

  16. Ogaya-Pinies G, Palayapalam-Ganapathi H, Rogers T, Hernandez-Cardona E, Rocco B, Coelho RF, Jenson C, Patel VR (2017) Can dehydrated human amnion/chorion membrane accelerate the return to potency after a nerve-sparing robotic-assisted radical prostatectomy? Propensity score-matched analysis. J Robot Surg. https://doi.org/10.1007/s11701-017-0719-8(Epub ahead of print)

    Article  PubMed  Google Scholar 

  17. Coughlin G, Dangle PP, Patil NN, Palmer KJ, Woolard J, Jensen C, Patel V (2008) Surgery Illustrated–focus on details. Modified posterior reconstruction of the rhabdosphincter: application to robotic-assisted laparoscopic prostatectomy. BJU Int 102(10):1482–1485

    Article  Google Scholar 

  18. Coelho RF, Chauhan S, Orvieto MA, Sivaraman A, Palmer KJ, Coughlin G, Patel VR (2011) Influence of modified posterior reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol 59(1):72–80

    Article  Google Scholar 

  19. Hemal AK, Agarwal MM, Babbar P (2012) Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol 44(1):125–132

    Article  Google Scholar 

  20. Tewari AK, Srivastava A, Sooriakumaran P et al (2010) Use of a novel absorbable barbed plastic surgical suture enables a ‘self-cinching’ technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol 24(10):1645–1650

    Article  Google Scholar 

  21. Moran ME, Marsh C, Perrotti M (2007) Bidirectional-barbed sutured knotless running anastomosis v classic van Velthoven suturing in a model system. J Endourol 21(10):1175–1177

    Article  Google Scholar 

  22. de Carvalho PA, Barbosa J, Guglielmetti GB, Cordeiro MD, Rocco B, Nahas WC et al (2018) Retrograde release of the neurovascular bundle with preservation of dorsal venous complex during robot-assisted radical prostatectomy: optimizing functional outcomes. Eur Urol. https://doi.org/10.1016/j.eururo.2018.07.003

    Article  PubMed  Google Scholar 

  23. Moschovas MC, Bhat S, Rogers T, Onol F, Roof S, Mazzone E et al (2020) Technical modifications necessary to implement the da Vinci single-port robotic system. Eur Urol. https://doi.org/10.1016/j.eururo.2020.01.005

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sood A, Jeong W, Peabody JO, Hemal AK, Menon M (2014) Robot-assisted radical prostatectomy: inching toward gold standard. Urol Clin North Am 41(4):473–484

    Article  Google Scholar 

  25. Rocco F, Gadda F, Acquati P, Carmignani L, Favini P, Dell'Orto P, Ferruti M, Avogadro A, Casellato S, Grisotto M (2001) Personal research: reconstruction of the urethral striated sphincter. Arch Ital Urol Androl 73(3):127–137

    CAS  PubMed  Google Scholar 

  26. Grasso AA, Mistretta FA, Sandri M, Cozzi G, De Lorenzis E, Rosso M, Albo G, Palmisano F, Mottrie A, Haese A, Graefen M, Coelho R, Patel VR, Rocco B (2016) Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis. BJU Int 118(1):20–34

    Article  Google Scholar 

  27. Kumar A, Tandon S, Samavedi S, Mouraviev V, Bates AS, Patel VR (2016) Current status of various neurovascular bundle-sparing techniques in robot-assisted radical prostatectomy. J Robot Surg 10(3):187–200

    Article  Google Scholar 

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Authors and Affiliations

  1. Global Robotics Institute, Advent Health Celebration Health, Suite 200, 410 Celebration Place, Celebration, FL, 34747, USA

    Kulthe Ramesh Seetharam Bhat, Marcio Covas Moschovas, Fikret Fatih Onol, Travis Rogers, Sunil Sandadi Reddy, Cathy Corder, Shannon Roof & Vipul R. Patel

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  1. Kulthe Ramesh Seetharam Bhat
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  2. Marcio Covas Moschovas
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  3. Fikret Fatih Onol
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  4. Travis Rogers
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  5. Sunil Sandadi Reddy
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  6. Cathy Corder
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  7. Shannon Roof
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  8. Vipul R. Patel
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Correspondence to Kulthe Ramesh Seetharam Bhat.

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Conflict of interest

Dr. Seetharam Bhat, Dr. Fikret Onol, Dr. Marcio Covas Moschovas, Dr. Travis Rogers, Dr. Sunil Reddy, Cathy Corder, Shannon Roof, and Dr. Vipul Patel declare that they have no conflict of interest or competing financial interests related to the manuscript. Dr. Vipul Patel is a consultant for Exact Sciences/Genomic Health, Decipher/Genomic DX, Active Surgical, and AVRA.

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Informed consent is not applicable. This is a descriptive study compiling the main authors technical modifications to radical prostatectomy.

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Bhat, K.R.S., Moschovas, M.C., Onol, F.F. et al. Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases. J Robotic Surg 15, 651–660 (2021). https://doi.org/10.1007/s11701-020-01157-5

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  • DOI: https://doi.org/10.1007/s11701-020-01157-5

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