Robot-assisted partial prostatectomy for anterior prostate cancer: a step-by-step guide.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Anterior prostate cancer (APC) presents unique surgical challenges.
• Magnetic resonance imaging (MRI) aids in detecting isolated APC.
• Robot-assisted anterior partial prostatectomy (RA-APP) is an emerging technique.

Purpose of the Study:

• To provide a step-by-step guide for performing RA-APP.
• To evaluate the feasibility and safety of RA-APP for MRI-detected APC.
• To assess perioperative outcomes and potential for salvage surgery.

Main Methods:

• A prospective, single-arm, IDEAL phase 2a study involving 17 patients.
• RA-APP technique detailed in three dissection steps: retrograde apical, antegrade at bladder neck, and lateral.
• Standard transperitoneal robotic approach with specific port placement.

Main Results:

• RA-APP was feasible in all cases with no open conversion.
• Only Clavien-Dindo grade II perioperative complications were observed.
• Robot-assisted completion of prostatectomy was possible in four cases with cancer recurrence.

Conclusions:

• Prostate-sparing RA-APP is a feasible and safe option for selected men with isolated APC.
• RA-APP offers an alternative to focal ablative therapies.
• The technique demonstrated good perioperative outcomes and salvageability.