Retzius-Sparing Robot-Assisted Laparoscopic Radical Prostatectomy
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.
KeywordsProstatectomy 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).
- 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. https://doi.org/10.1016/j.eururo.2010.06.008.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.eururo.2013.06.046.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1111/j.1464-410X.2011.10849.x.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.eururo.2006.10.014.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.eururo.2010.07.021.CrossRefPubMedGoogle Scholar