Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes

SIMPLE SUMMARY: Robotic radical prostatectomy is a treatment for prostate cancer. The lateral approach radical prostatectomy technique allows total preservation of the anterior pubovesical complex, as well as vascular and nervous structures in close contact with the prostate, involved in continence and male potency. We analyzed more than 500 patients undergoing robotic radical prostatectomy using the lateral approach technique, operated by two surgeons at our institution, from January 2015 to March 2021. The technique is reproduced by both surgeons, the oncological and functional results are outstanding with this technique, which means that it is a successful treatment to cure prostate cancer, preserving excellent urinary continence and sexual function. ABSTRACT: Background: Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters. Methods: We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared. Results: When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2. Conclusions: Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.