Early continence assessment in retzius sparing robot Assisted radical prostatectomy using CMR versius® robotic...

Retzius-sparingrobot-assisted radical prostatectomy (RS-RARP) has been shown to significantlyimprove postoperative continence outcomes. Traditionally, this technique isperformed using the Da Vinci® Surgical System. To evaluatealternative robotic systems, we conducted RS-RARP procedures using the Versius® robotic surgical system. This report presents the functional outcomes of ourinitial experience and contributes to the growing body of evidence supportingthe feasibility and efficacy of the Versius® roboticsurgical system in RS-RARP.

This prospective,non-randomized observational study included 50 patients who underwent RS-RARPusing the Versius® robotic surgical system with four bedside units.Surgeries were performed at Cairo University Hospitals (King Fahd Unit) and theRobosurge Center, Cleopatra Hospital Group (CHG) S.A.E. Cairo, Egypt, betweenDecember 2023 and August 2024. The procedure began with a horizontal incisionin the posterior peritoneum. The vasa deferentia were identified and transectedbilaterally. Seminal vesicles were mobilized and dissected after vascularcontrol. Denonvilliers' fascia was incised to develop the posterior planetoward the prostate-urethral junction. Prostatic pedicles were ligated anddivided, followed by lateral dissection to the apex and exposure of the dorsalvein complex. The bladder neck was sharply dissected. Anterior dissection wasperformed while preserving the detrusor and anterior pubovesical complex Urethrovesical anastomosis wascompleted using two 3-0 V-Loc™ sutures.

Earlycontinence - defined as use of 0-1 safety pad/day - was achieved in 90% ofpatients, rising to 96% at 6 months. An IIEF-5 score ≥17 was reported in 32% ofpatients at 1, 3, and 6 months postoperatively. The mean operative time was192.9 ± 7.5 minutes, with a mean prostate volume of 51.9 ± 15.9 grams and meanestimated blood loss of 82 mL. The average hospital stay was 2 days, andcatheter removal occurred after a mean of 7 days. Complications occurred in 10%of cases (n = 5), and the positive surgical margin (PSM) rate was 6%.

RS-RARP using the Versius® robotic surgical system is feasible and demonstrates favorable early outcomes in terms of continence,potency, and oncological safety. Further studies with larger cohorts andextended follow-up are warranted to validate these findings.