Clipless robot-assisted Retzius-sparing radical prostatectomy: a study on its safety profile and outcomes

Retzius-sparing RARP (RS-RARP) is a modification of the standard RARP technique that traditionally requires clips to control the pedicles. We aimed to retrospectively analyze the operative, oncological, and functional outcomes of this altogether 'clipless' approach to RS-RARP from our centre. The study was conducted as a retrospective audit in our department. We included consecutive patients who underwent clipless-RS-RARP in our centre from February 2023 to December 2023. The clipless RS-RARP was done with the daVinci Xi system in all cases (primary surgeon-author WAC). No clips were used in these procedures and the preoperative, intra-operative, and postoperative data were recorded with at least 3 months of follow-up. Continence was defined as zero pad usage. A total of 138 patients underwent RS-RAP using the clipless technique during the study period. The median age was 64 years, with a median BMI of 27.25 kg/m². 88.41% were ISUP 1-3 group patients. 82.61% were cT2, 17.39% were cT3, and 13.77% had median lobe in MRI. The mean console time was 99 min, with 81.16% having bilateral nerve spare, 17.39% unilateral spare, and 1.45% having none. 38.41% were fit to be discharged on the same day/evening of admission/surgery. There were no major complications (Clavien-Dindo [CD] ≥ 3) or postoperative bleeding. The margin positivity rate was 19.50%, of which 62.95% were stage ≥ pT3a. The continence rates were 86.2% at 6 weeks 89.1% at 3 months and 93.4% at 6 months. The potency and biochemical recurrence rates were 79% and 3.6%, respectively, at 6 months.Clipless RS-RARP is a safe procedure with good oncological and early continence recovery. This modification avoids clip-related complications without the expense of any higher complication rates compared to a standard RARP.