Dr. Sónia Ramos

Is the Retzius-Sparing Laparoscopic Radical Prostatectomy feasible?

Radical Prostatectomy remains one of the surgeries most often performed by urologists and a main treatment option for prostate cancer. There are several approaches: the open radical prostatectomy (ORP), the laparoscopic radical prostatectomy (LRP) and the robot laparoscopic-assisted radical prostatectomy (RARP). Many studies have compared these different approaches. However, they have failed to show clear superiority in functional and in oncological outcomes. Therefore, there is a growing interest in developing new surgical techniques in order to improve these outcomes. The Retzius-sparing RARP was developed by the Bocciardi group in 2010. In this approach, the anterior compartment and its structures are spared. The rationale behind it is the contribution of these structures to the continence and potency, therefore by preserving them, better functional outcomes would be obtained. Recent meta-analyses comparing it to anterior RARP have been published and the quality of the evidence has been growing. On the functional outcomes, in terms of continence, it was associated with better early and late continence. When concerning potency, data is lacking, with results suggesting possible advantage. On safety outcomes, complication rates have been similar. When concerning oncological outcomes, no differences appear to exist between groups. However, there has been discussion about anterior positive surgical margins. The Retzius-sparing approach on LRP has no published studies. The surgical steps used have been the same of the RARP. Technically, it can be more challenging since the surgical instruments are straight. Its utilization might be an advantage in centers where the RARP is not available. The transposition of this technique to LRP is feasible in the hands of an experienced laparoscopic surgeon. The Retzius-sparing LRP might provide the same functional advantages already demonstrated by the RARP.