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Eur Urol Focus. 2018 Sep;4(5):677-685. doi: 10.1016/j.euf.2018.01.004. Epub 2018 May 7.

A Novel Approach for Apical Dissection During Robot-assisted Radical Prostatectomy: The "Collar" Technique.

Author information

1
Department of Urology, OLV Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Bologna, Bologna, Italy.
2
Department of Urology, OLV Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Pisa, Pisa, Italy.
3
Department of Urology, OLV Aalst, Belgium; ORSI Academy, Melle, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
4
Department of Urology, OLV Aalst, Belgium.
5
Department of Urology, OLV Aalst, Belgium; ORSI Academy, Melle, Belgium. Electronic address: a.mottrie@gmail.com.

Abstract

BACKGROUND:

Apical dissection in robot-assisted radical prostatectomy (RARP) affects not only cancer control, but also continence recovery.

OBJECTIVE:

To describe a novel approach for apical dissection, the collar technique, to reduce apical positive surgical margins (PSMs).

DESIGN, SETTING, AND PARTICIPANTS:

A total of 189 consecutive patients (81 in the control group, 108 in the collar technique group) underwent RARP at a single center.

PRIMARY OUTCOME:

rates of apical PSMs; secondary outcome: urinary continence.

INTERVENTION:

The urethral sphincter complex is incised 2-3mm distally to the apex, to stay farther from it and reduce PSMs; the underlying smooth muscle is exposed and incised closer to the apex to preserve the maximal length of the lissosphincter.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Mann-Whitney U and chi-square tests compared median and proportions between the two groups, respectively. Univariate logistic regression tested the association between technique employed and risk of apical PSMs.

RESULTS AND LIMITATIONS:

Fourteen patients (7.4%) revealed apical PSMs (9.9% in the control group, 5.6% in the collar group; p=0.7). When the collar technique was used, significantly lower rates of apical PSMs occurred in pT2 disease (0% vs 7.1%; p=0.03). In case of apical tumor at preoperative magnetic resonance imaging (MRI; n=43), the collar technique determined significantly lower overall (9.7% vs 42%) and apical (3.2% vs 42%) PSMs (all p≤0.02). Continence recovery in the collar and control groups was similar. When preoperative MRI showed an apical tumor, the collar technique had a significantly lower risk of apical PSMs (odds ratio: 0.05, p=0.009).

CONCLUSIONS:

The collar technique reduces the rates of apical PSMs in case of apical tumor, preserving the length of the lissosphincter.

PATIENT SUMMARY:

We describe a novel approach for apical dissection during robot-assisted radical prostatectomy. Our technique reduces the rates of apical surgical margins in case of apical tumor at preoperative magnetic resonance imaging and leads to optimal continence recovery.

KEYWORDS:

Apical dissection; Apical tumor; Positive surgical margins; Robot-assisted radical prostatectomy; Technical modification; Urinary continence recovery

PMID:
29402756
DOI:
10.1016/j.euf.2018.01.004
[Indexed for MEDLINE]

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