Comparative Research Of Transvesical Robotic Assisted Laparoscopic Prostatectomy And Retzius Sparing Robotic Assisted Laparoscopic Prostatectomy

Objective:To compare the clinical efficacy differences of Transvesical robotic assisted laparoscopic prostatectomy(TvRRARP)and Retzius sparing robotic assisted laparoscopic prostatectomy(RsRARP)Methods:We performed 23 RsRARP and 27 TvRARP in the First Affiliated Hospital of Nanchang University from October 2016 to December 2019.Researcher collected and analyzed a series of related clinical data including preoperative parameter?total prostate specific antigen?clinical staging?biopsy Gleason score?operative time?estimate blood loss?intraoperative complication?pathological Gleason score?pathological staging?continence rate and oncology outcome(positive surgical margin and biochemical recurrence)retrospectively.Results:In terms of preoperative data,the average age of patients in RsRARP group and TvRARP group was(68.3±4.4 years VS 69.6±7.4 years),and the average BMI was(22.1±2.2kg/m2 VS 23.5±3.4 kg/m2).Furthermore,the median preoperative serum tPSA of the above two groups was 17.1(12.9-28.8)VS 16.9ng/ml(9.4-24.4ng/ml),and the prostate volume was 36.8(29.9-43.8)VS 34.4ml(17.5-54.6ml).In addition,the number of cases with Gleason score ?6,7,?8 points in groups RsRARP and TvRARP were 11,10,2 and 15,10,2 respectively(Not statistical significant,P>0.05).The clinical staging T1c,T2a,T2b,T2c cases in groups RsRARP and TvRARP was 15,3,3,2 and 14,8,3,2 respectively(Not statistical significant,P>0.05).None of the patients received hormonal therapy preoperatively.All patients were successfully performed surgery under general anesthesia without conversion,transfusion and serious intraoperative complications.The reported operative time of the RsRARP group and TvRARP group was 168.5±49.8min VS 183.7±37.3min,and the estimated blood loss was 131.7±66.9ml VS 150.6±69.3ml.The pathology staging T2a?T2b?T2c?T3 cases in groups RsRARP and TvRARP was 10,8,3,2 and 9,8,6,4 respectively(Not statistical significant,P>0.05).The number of cases with Gleason score ?6,7,?8 points in groups RsRARP and TvRARP was 9,10,4 and 12,10,5 respectively(Not statistical significant,P>0.05).Furthermore,positive surgical margin was reported 26.1%in RsRARP group and 14.8%in TvRARP(Not statistical significant,P>0.05).As for the follow up period after the surgery,the continence rate at the moment of removing catheter?1 month?3 months postoperatively was 82.6%,100%,100%VS 85.2%,100%,100%in the RsRARP group and TvRARP group respectively(Not statistical significant,P>0.05).Univariate regression analysis suggested that patient's age?BMI?tPSA?prostate volume?operative time and estimate blood loss had no correlation with continence recovery rate at the moment of removing catheter in TvRARP group.During a median follow up of 16 months(4-36 months),no sign of biochemical recurrence was found(tPSA<0.2ng/ml).However,one patient developed urinary stricture and one patient had abdominal incisional hernia in TvRARP group,there were also one patient presented with urinary stricture in RsRARP.Conclusions:TvRARP is a feasible surgical method for radical prostatectomy.,which is a surgical approach that can spare the Retzius space and achieve complete intrafascia resection.Also it can protect the continence mechanism without compromising the surgical efficacy,therefore patient rebuild their continence function in short term.We can expect this new approach to be one of the surgical treatment methods for localized prostate cancer in the future.