Open radical prostatectomy reproducing robot-assisted radical prostatectomy: Involving antegrade nerve sparing and continuous anastomosis

ABSTRACT Purpose: To present modified RRP using the same method as RALP and compare its surgical outcomes with RALP. Materials and Methods: Demographics, perioperative and functional outcomes of the 322 patients that underwent RRP (N=99) or RALP (N=223) at our institution from January 2011 through June 2013 were evaluated retrospectively. Postoperative incontinence and erectile dysfunction are involved functional outcomes. During the modified procedure, the bladder neck was dissected first as for RALP. After dissection of vas deference and seminal vesicle, the prostate was dissected in an antegrade fashion with bilateral nerve saving. Finally, the urethra was cut at the prostate apex. After a Rocco suture was applied, and then urethrovesical anastomosis was performed with continuous suture as for RALP. Results: Perioperative characteristics and complication rates were similar in the RRP and RALP groups except for mean estimated blood loss (p<0.001) and operative time (p<0.001). Incontinence rates at 3 and 12 months after RRP decreased from 67.6% to 10.1 and after RALP decreased from 53.4% to 5.4%. Positive surgical margin rates were non-significantly different in the RRP and RALP groups (30.3% and 37.2%, respectively). Overall postoperative potency rate at 12 months was not significant different in RRP and RALP groups (34.3% and 43.0%). Conclusions: RRP reproducing RALP was found to have surgical outcomes comparable to RALP. This technique might be adopted by experienced urologic surgeons as a standard procedure.

摘要 研究目的：本研究旨在介绍采用与机器人辅助腹腔镜前列腺切除术（Robot-assisted Laparoscopic Prostatectomy, RALP）相同术式改良的根治性耻骨后前列腺切除术（Radical Retropubic Prostatectomy, RRP），并对比其与RALP的手术结局。材料与方法：回顾性分析2011年1月至2013年6月于本机构接受RRP（N=99）或RALP（N=223）的322例患者的人口学资料、围手术期指标及功能结局。本研究的功能结局指标包括术后尿失禁与勃起功能障碍。改良术式操作流程如下：首先参照RALP的步骤先行膀胱颈游离；于完成输精管与精囊游离后，采用顺行游离技术联合双侧神经保留策略游离前列腺；最终于前列腺尖部离断尿道。完成Rocco缝合后，采用与RALP一致的连续缝合方式实施尿道膀胱吻合术。结果：除平均估计失血量（p<0.001）与手术时长（p<0.001）外，RRP组与RALP组的围手术期特征及并发症发生率均无显著差异。RRP组术后3个月与12个月的尿失禁发生率分别从67.6%降至10.1%，RALP组则从53.4%降至5.4%。两组的手术切缘阳性率无显著统计学差异，分别为30.3%与37.2%。术后12个月的总体勃起功能恢复率在RRP组与RALP组间无显著差异，分别为34.3%与43.0%。结论：采用RALP术式流程改良的RRP，其手术结局与RALP相当。该技术可被经验丰富的泌尿外科医师作为标准术式推广应用。