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Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?

Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms o...

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Autores principales: Kang, Sung Gu, Shim, Ji Sung, Onol, Fikret, Bhat, K. R. Seetharam, Patel, Vipul R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Urological Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946819/
https://www.ncbi.nlm.nih.gov/pubmed/31942457
http://dx.doi.org/10.4111/icu.2020.61.1.1
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author Kang, Sung Gu
Shim, Ji Sung
Onol, Fikret
Bhat, K. R. Seetharam
Patel, Vipul R.
author_facet Kang, Sung Gu
Shim, Ji Sung
Onol, Fikret
Bhat, K. R. Seetharam
Patel, Vipul R.
author_sort Kang, Sung Gu
collection PubMed
description Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared).
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spelling pubmed-69468192020-01-15 Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome? Kang, Sung Gu Shim, Ji Sung Onol, Fikret Bhat, K. R. Seetharam Patel, Vipul R. Investig Clin Urol Review Article Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared). The Korean Urological Association 2020-01 2020-01-02 /pmc/articles/PMC6946819/ /pubmed/31942457 http://dx.doi.org/10.4111/icu.2020.61.1.1 Text en © The Korean Urological Association, 2020 http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Kang, Sung Gu
Shim, Ji Sung
Onol, Fikret
Bhat, K. R. Seetharam
Patel, Vipul R.
Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?
title Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?
title_full Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?
title_fullStr Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?
title_full_unstemmed Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?
title_short Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?
title_sort lessons learned from 12,000 robotic radical prostatectomies: is the journey as important as the outcome?
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946819/
https://www.ncbi.nlm.nih.gov/pubmed/31942457
http://dx.doi.org/10.4111/icu.2020.61.1.1
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