Contemporary Techniques of Prostate Dissection for Robot-assisted Prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted radical prostatectomy (RARP) techniques evolve to optimize oncological and functional results.
• Various surgical approaches and dissection methods are employed in RARP.

Purpose of the Study:

• To present an evidence-based overview of current RARP dissection techniques.
• To illustrate these surgical approaches with video demonstrations.

Main Methods:

• Literature search for RARP approaches and techniques.
• Analysis of supporting data for different surgical methods.
• Inclusion of expert-provided video material for technique illustration.

Main Results:

• Multiple RARP approaches exist, including extraperitoneal, transvesical, transperitoneal (anterior/posterior), Retzius-sparing, and transperineal.
• Techniques focus on endopelvic fascia dissection, bladder neck/nerve sparing, and preserving puboprostatic ligaments/dorsal venous complex.
• Retzius-sparing RARP shows potential for earlier return to continence, though margin status requires further investigation.

Conclusions:

• Several RARP approaches and dissection techniques are available.
• The Retzius-sparing approach may offer faster continence recovery compared to traditional methods.
• No single RARP technique has demonstrated superiority in long-term outcomes through randomized trials.