Apical dissection during radical retropubic prostatectomy without ligature

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Hemostasis of the venous plexus during radical retropubic prostatectomy is critical.
• Preventing excessive blood loss is essential for patient safety and surgical success.
• Preserving urethral length and neurovascular bundles is key for functional outcomes.

Purpose of the Study:

• To evaluate a novel bipolar coagulation technique for venous plexus hemostasis.
• To assess the impact of this technique on intra-operative blood loss and surgical precision.
• To compare functional outcomes (continence, potency) with the standard approach.

Main Methods:

• Development and application of a careful bipolar coagulation technique for the venous plexus.
• Comparison of intra-operative blood loss and transfusion rates against the standard surgical approach.
• Assessment of surgical precision, including urethral length preservation and apical notch extirpation.
• Evaluation of postoperative continence and potency at a mean 14-month follow-up.

Main Results:

• Significant reduction in intra-operative blood loss compared to the standard approach.
• Reduced need for blood transfusions.
• Improved surgical field visibility, facilitating better preservation of urethral length and neurovascular bundles.
• Postoperative continence and potency were comparable to the standard approach.

Conclusions:

• Bipolar coagulation of the venous plexus offers a promising alternative for radical retropubic prostatectomy.
• This technique may lead to improved surgical precision and reduced complications.
• Further long-term, multicenter studies are needed to confirm cancer control and long-term functional equivalence.