3D Laparoscopic Radical Prostatectomy: The Romolo Hospital Experience

To describe a standardized surgical approach for 3D transperitoneal laparoscopic radical prostatectomy (3D T-LRP) performed in a single high-volume surgical center and to assess its impact on early urinary continence, erectile function, oncological outcomes, and overall safety.

We conducted a retrospective analysis of 360 patients with clinically localized prostate cancer (cT1-T2, N0, and M0) who underwent 3D T-LRP at Romolo Hospital (Italy) between January 2018 and December 2022. Procedures were performed by two experienced surgical teams with standardized operative protocols. All patients followed a structured pelvic floor rehabilitation protocol initiated immediately after catheter removal. Perioperative variables, functional outcomes (continence and erectile function), oncological parameters, and complications were prospectively recorde.d in an institutional database and retrospectively analyzed.

The median operative time was 180 minutes (interquartile range [IQR]: 150-210), with pelvic lymph node dissection performed in 44.2% of cases. Positive surgical margins were observed in 15% of patients. Continence (defined as 0-1 pad/day) was achieved in 75.8% at 1 week, 83.4% at 3 months, and 92.5% at 6-12 months post-catheter removal. The median pad weight decreased from 350 g at T0 to 50 g at T1. In the nerve-sparing subgroup, the median IIEF-5 score at 6-12 months was 18 (IQR: 16-20), with 83% achieving a score ≥16. The postoperative complication rate was 10.3%, with no Clavien-Dindo grade ≥IIIb events.

3D T-LRP performed with a standardized technique by experienced teams and followed by immediate pelvic floor rehabilitation yielded encouraging results in terms of early continence, erectile function, oncological safety, and low morbidity. These outcomes support 3D-LRP as a technically effective and economically sustainable minimally invasive alternative to robotic surgery.