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

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Standard Retzius-sparing radical prostatectomy (RS-RARP) often uses clips for pedicle control.
• Clip application can be associated with potential complications.
• A 'clipless' modification of RS-RARP aims to mitigate these risks.

Purpose of the Study:

• To retrospectively analyze the operative, oncological, and functional outcomes of a clipless RS-RARP approach.
• To evaluate the safety and efficacy of performing RS-RARP without clips.

Main Methods:

• Retrospective audit of consecutive patients undergoing clipless RS-RARP from February to December 2023.
• Procedures performed using the da Vinci Xi system.
• Data collection included pre-operative, intra-operative, and post-operative parameters with at least 3 months follow-up.

Main Results:

• 138 patients included; median age 64 years, median BMI 27.25 kg/m².
• No major complications (Clavien-Dindo ≥3) or postoperative bleeding observed.
• Continence rates reached 93.4% at 6 months; potency 79% and biochemical recurrence 3.6% at 6 months.

Conclusions:

• Clipless RS-RARP is a safe and feasible technique.
• The approach demonstrates good oncological control and facilitates early continence recovery.
• Eliminating clips avoids clip-related complications without increasing overall complication rates.