A comparative study of Retzius-sparing technique with veil of Aphrodite technique nerve sparing robotic-assisted laparoscopic radical prostatectomy

Objective To introduce the technique and report our initial experience of Retzius-sparing robotic-assisted laparoscopic radical prostatectomy (RALP) and compare perioperative outcomes with the standard veil of Aphrodite technique (Veil technique). Methods nineteen Retzius-sparing RALP and 20 Veil nerve sparing RALP with posterior reconstruction for T1c to T2c prostate cancer performed by a single surgical team between 2015 January and 2016 December were retrospectively reviewed. Preoperative data of patients in Retzius-sparing group [patient age (66.3±5.9) years, BMI (25.5±3.1) kg/m2, tPSA (16.4±5.0) ng/ml, biopsy Gleason score 6(5-7), prostate volume (32.7±7.4) ml and IIEF-5 score 14(5-18)] and Veil group[ patient age (64.6±7.3) years, BMI (25.5±2.0) kg/m2, tPSA (18.5±11.0) ng/ml, biopsy Gleason score 7(5-8), prostate volume (31.4±10.8)ml and IIEF-5 score 15(6-19)]. No significant difference was found between the two group in the above parameters (all P>0.05). All patients were continent preoperatively. Retzius-sparing RALP and Veil nerve sparing RALP were performed via transperitoneal RALP. Operative time, estimated blood loss, postoperative hospital stay, postoperative staging, postoperative Gleason score, return of urinary continence and postoperative IIEF-5 score of the two groups were statistically analyzed. Results All 39 cases were successfully performed robotically without conversion, transfusion or other major intraoperative and postoperative complications. Postoperative pathology confirmed pT2a 5 cases, pT2b 8 cases and pT2c 6 cases in Retzius-sparing group and pT2a 7 cases, pT2b 5 cases and pT2c 8 cases in Veil group (all P>0.05). For Retzius group, operative time was (106.5±26.4) min and estimated blood loss was (48.9±20.2) ml; for Veil group, operative time was (93.2±20.8) min and estimated blood loss was (42.5±16.8) ml. No significant difference was found in the above parameters (all P>0.05). Urethral catheter was removed at postoperative 7-day (Retzius-sparing group) and 21-day (Veil group), respectively. 18 patients in Retzius-sparing group achieved urinary continence (0 pads) immediately after the removal of urinary catheter, while 1 patient returned to full continence in 2 weeks postoperatively. Patients in Veil group returned to continence (6.8±3.6) weeks postoperatively (P 0.05). No sign of tumor recurrence was appreciated for all cases (tPSA<0.2 ng/ml) during follow-up of 6 months (3 to 12 months). Conclusions Retzius-sparing RALP and the Veil nerve sparing RALP were both effective for the surgical treatment of localized prostate cancer. Our data revealed no statistical difference in perioperative outcomes between the two approaches, however, the Retzius-sparing technique seemed to yield a better outcome regarding early return to urinary continence postoperatively. Key words: Robotic-assisted laparoscopic radical prostatectomy(RALP); Retzius-sparing technique; Veil of Aphrodite technique; Postoperative continence