Perineal robot-assisted laparoscopic radical prostatectomy: feasibility study in the cadaver model

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Radical prostatectomy is a standard treatment for localized prostate cancer.
• Minimally invasive techniques, including robot-assisted laparoscopic radical prostatectomy (RALP), aim to reduce morbidity.
• The perineal approach offers potential advantages in terms of cosmesis and reduced pelvic trauma.

Purpose of the Study:

• To assess the feasibility of performing perineal robot-assisted laparoscopic radical prostatectomy (P-RALP).
• To evaluate the P-RALP technique in a cadaver model.
• To establish a foundation for future clinical investigations of P-RALP.

Main Methods:

• P-RALP was performed in three cadavers using a single-port device and robotic docking.
• Key surgical steps included dissection of the posterior and anterior planes, seminal vesicle dissection, urethral transection, and vesicourethral anastomosis.
• The procedure involved division of the rectourethralis muscle and splitting of the levator ani fibers.
• Cystoscopy and histopathology were used to assess the anastomosis and specimen integrity.

Main Results:

• Nerve-sparing P-RALP was successfully completed in all three cadavers.
• The median total operative time was 89 minutes.
• The prostate capsule remained grossly intact, with negative margins in distal urethral sections and most bladder neck sections.

Conclusions:

• Perineal robot-assisted laparoscopic radical prostatectomy (P-RALP) is a feasible procedure in a cadaver model.
• Further research is warranted to explore lymph node dissection via the same incision.
• Clinical feasibility and comparative studies against standard techniques are recommended next steps.