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Clipless Robotic-assisted Radical Prostatectomy and Impact on Outcomes.

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Summary

Robotic-assisted radical prostatectomy (RARP) using bipolar energy for clipless dissection is as effective as the standard clip technique. This approach offers similar oncological and functional outcomes without increasing complications.

Keywords:
Bipolar energyOutcomesProstate cancerProstatectomy

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Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • The standard for robotic-assisted radical prostatectomy (RARP) involves surgical clips for athermal dissection of prostatic pedicles and ligation during pelvic lymph node dissection (PLND).
  • Clips are used to prevent thermal injury to nerve fibers and reduce lymphocele formation.

Purpose of the Study:

  • To compare the oncological and functional outcomes of a novel clipless RARP technique using bipolar energy (RARP-bi) against the standard clip-based technique (RARP-c).

Main Methods:

  • A retrospective study compared 338 men undergoing RARP between July 2018 and March 2020.
  • Data on demographics, clinicopathology, urinary and sexual function (using Expanded Prostate Cancer Index for Clinical Practice), and complications (Clavien-Dindo grading) were collected and analyzed.
  • Multivariable regression modeling assessed the association of RARP-bi versus RARP-c with positive surgical margins (PSMs) and functional scores.

Main Results:

  • No significant differences were observed in oncological outcomes (PSMs) or functional outcomes (urinary and sexual function) between RARP-bi and RARP-c.
  • The RARP-bi technique was not associated with significant differences in PSMs (OR = 1.04), sexual function (OR = 0.4), or urinary function (OR = 0.5).
  • Overall complication rates (12% vs 16%), bladder neck contracture rates (2.1% vs 3.6%), and lymphocele complications (1.4% vs 0.52%) were similar between the groups, with all complications being low-grade (Clavien-Dindo I-II).

Conclusions:

  • The clipless RARP technique utilizing bipolar energy is oncologically and functionally equivalent to the standard clip technique.
  • This approach does not increase the risk of nerve injury, complications, or lymphocele formation compared to using surgical clips.
  • The clipless technique may offer advantages such as shorter operative time without compromising patient outcomes.