Retzius-Sparing Robot-Assisted Laparoscopic Radical Prostatectomy

  • K. D. Chang
  • C. K. Oh
  • K. H. RhaEmail author


The Bocciardi approach for RALP passes through the Douglas space, following a completely intrafascial plane without any dissection of the anterior compartment, which contains neurovascular bundles, Aphrodite’s veil, endopelvic fascia, the Santorini plexus, pubourethral ligaments, and all of the structures throught to play a role in maintenance of continence and potency. In the era of Robot assisted laparoscopic prostatectomy (RALP) including various techniques of anterior suspension and posterior reconstruction. Most of these techniques aim to restore the normal anatomy so that functional outcomes can be optimized. Nearly all published techniques to date have involved dropping the bladder and entering the Retzius space at some point during RALP. Galfano et al. reported they performed a novel Retzius-sparing RALP in three out of five patients in 2010. Since introducing this technique, we have applied this technique on prostatectomy more than 800 cases. Our Retzius-sparing RALP technique is similar to that described by Galfano et al. but there are some modified technique compare to Galfano’s.


Prostatectomy Robotic Retzius-sparing 



This research was supported by the Korean ministry of science and ICT to the Human plus fusion research and development challenge project in 2018 (NRF-2018M3C1B8017157).


  1. Abbou CC, Hoznek A, Salomon L, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D. Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol. 2000;10(4):520–3.PubMedGoogle Scholar
  2. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408–10.CrossRefGoogle Scholar
  3. Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM. A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol. 2010;58(3):457–61. Scholar
  4. Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM. Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with >/= 1 year of follow-up. Eur Urol. 2013;64(6):974–80. Scholar
  5. Hurtes X, Roupret M, Vaessen C, Pereira H, Faivre d'Arcier B, Cormier L, Bruyere F. Anterior suspension combined with posterior reconstruction during robot-assisted laparoscopic prostatectomy improves early return of urinary continence: a prospective randomized multicentre trial. BJU Int. 2012;110(6):875–83. Scholar
  6. Jeong W, Araki M, Park SY, Lee YH, Kumon H, Hong SJ, Rha KH. Robot-assisted laparoscopic radical prostatectomy in the Asian population: modified port configuration and ultradissection. Int J Urol. 2010;17(3):297–300. Scholar
  7. Lim SK, Kim KH, Shin TY, Han WK, Chung BH, Hong SJ, Choi YD, Rha KH. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int. 2014;114(2):236–44. Scholar
  8. Menon M, Shrivastava A, Bhandari M, Satyanarayana R, Siva S, Agarwal PK. Vattikuti Institute prostatectomy: technical modifications in 2009. Eur Urol. 2009;56(1):89–96. Scholar
  9. Menon M, Tewari A, Peabody J, Team VIP. Vattikuti Institute prostatectomy: technique. J Urol. 2003;169(6):2289–92. Scholar
  10. Patel VR, Coelho RF, Palmer KJ, Rocco B. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol. 2009;56(3):472–8. Scholar
  11. Potdevin L, Ercolani M, Jeong J, Kim IY. Functional and oncologic outcomes comparing interfascial and intrafascial nerve sparing in robot-assisted laparoscopic radical prostatectomies. J Endourol. 2009;23(9):1479–84. Scholar
  12. Rocco B, Gregori A, Stener S, Santoro L, Bozzola A, Galli S, Knez R, Scieri F, Scaburri A, Gaboardi F. Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol. 2007;51(4):996–1003. Scholar
  13. Stolzenburg JU, Schwalenberg T, Horn LC, Neuhaus J, Constantinides C, Liatsikos EN. Anatomical landmarks of radical prostatecomy. Eur Urol. 2007;51(3):629–39. Scholar
  14. Williams SB, Alemozaffar M, Lei Y, Hevelone N, Lipsitz SR, Plaster BA, Hu JC. Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes. Eur Urol. 2010;58(6):875–81. Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Urology, Urological Science InstituteYonsei University Wonju College of MedicineWonjuSouth Korea
  2. 2.Department of Urology, Haeundae Paik Hospital, Inje University College of MedicineBusanSouth Korea
  3. 3.Department of Urology, Urological Science InstituteYonsei University College of MedicineSeoulSouth Korea

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