Safety and functional outcomes of modified maximum peri-prostatic anatomy preserving-robotic assisted laparoscopic...

To describe a revised surgical approach for robotic-assisted laparoscopic radical prostatectomy and evaluate its safety, functional outcomes, urinary symptoms, quality of life, and short-term oncological results. A total of 61 patients at a large university hospital underwent modified maximum peri-prostatic anatomy preserving-robotic assisted laparoscopic radical prostatectomy (MPAP-RALP) from June 2019 to June 2022. The median surgery time and blood loss were 257.0 min and 200.0 mL. Three patients had Clavien-Dindo grade II complications, and only one patient had Clavien-Dindo grade III complications. No patients died. 12 (19.7%) patients with surgical margins. 13 (21.3%) and 9 (14.8%) patients had evidence of PSA persistence after 1 month and 6-8 postoperative weeks. Continence rates continued to improve at 1 month (95.1%), 3 months (95.1%), 6 months (96.7%), and 12 months after surgery. No patients had serious urinary symptoms, and 2 (3.3%) patients were dissatisfied after 1 month surgery about quality of life. In conclusion, the modified MPAP-RALP is feasible and can be performed safely by an experienced urologic surgeon. Preliminary evidence suggests that the modified MPAP-RALP facilitates early continence recovery, does not affect surgical margin rates, reduces surgical complications, and enhances quality of life.