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Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery
PURPOSE: To evaluate the impact of modifications to anatomical apical dissection including a puboprostatic open-collar technique, which visualizes the lateral aspect of the apex and dorsal vein complex (DVC) covering the rhabdosphincter while preserving the puboprostatic collar, on positive surgical...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049266/ https://www.ncbi.nlm.nih.gov/pubmed/33857230 http://dx.doi.org/10.1371/journal.pone.0249991 |
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author | Koga, Fumitaka Ito, Masaya Kataoka, Madoka Fukushima, Hiroshi Nakanishi, Yasukazu Takemura, Kosuke Suzuki, Hiroaki Sakamoto, Kazumasa Kobayashi, Shuichiro Tobisu, Ken-ichi |
author_facet | Koga, Fumitaka Ito, Masaya Kataoka, Madoka Fukushima, Hiroshi Nakanishi, Yasukazu Takemura, Kosuke Suzuki, Hiroaki Sakamoto, Kazumasa Kobayashi, Shuichiro Tobisu, Ken-ichi |
author_sort | Koga, Fumitaka |
collection | PubMed |
description | PURPOSE: To evaluate the impact of modifications to anatomical apical dissection including a puboprostatic open-collar technique, which visualizes the lateral aspect of the apex and dorsal vein complex (DVC) covering the rhabdosphincter while preserving the puboprostatic collar, on positive surgical margin (PSM) and continence recovery. METHODS: One-hundred-and-sixty-seven patients underwent gasless single-port retroperitoneoscopic radical prostatectomy using a three-dimensional head-mounted display system. Sequentially modified surgical techniques comprised puboprostatic open-collar technique, sutureless transection of the DVC, retrograde urethral dissection, and anterior reconstruction. The associations of these modifications with PSM and continence recovery were assessed. RESULTS: The puboprostatic open-collar technique, sutureless DVC transection, and retrograde urethral dissection were significantly associated with lower apical PSM (P = 0.003, 0.003, and 0.010, respectively). The former two also showed similar associations in 84 patients with anterior apical tumor (P = 0.021 and 0.030, respectively). Among 92 patients undergoing all of these three procedures, overall and apical PSM rates were 13.0% and 3.3%, respectively. Retrograde urethral dissection (odds ratio [OR] 2.73, P = 0.004) together with nerve sparing (OR 2.77, P = 0.003) and anterior apical tumor (OR 0.45, P = 0.017) were independently associated with immediate continence recovery. A multivariable model for 3-month continence recovery included anterior apical tumor (OR 0.28, P = 0.003) and puboprostatic open-collar technique (OR 3.42, P = 0.062). Immediate and 3-month continence recovery rates were 56.3% and 85.4%, respectively, in 103 patients undergoing both the puboprostatic open-collar technique and retrograde urethral dissection. CONCLUSION: Novel anatomical apical dissection utilizing a puboprostatic open-collar technique may favorably impact on both apical surgical margin and continence recovery. |
format | Online Article Text |
id | pubmed-8049266 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-80492662021-04-21 Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery Koga, Fumitaka Ito, Masaya Kataoka, Madoka Fukushima, Hiroshi Nakanishi, Yasukazu Takemura, Kosuke Suzuki, Hiroaki Sakamoto, Kazumasa Kobayashi, Shuichiro Tobisu, Ken-ichi PLoS One Research Article PURPOSE: To evaluate the impact of modifications to anatomical apical dissection including a puboprostatic open-collar technique, which visualizes the lateral aspect of the apex and dorsal vein complex (DVC) covering the rhabdosphincter while preserving the puboprostatic collar, on positive surgical margin (PSM) and continence recovery. METHODS: One-hundred-and-sixty-seven patients underwent gasless single-port retroperitoneoscopic radical prostatectomy using a three-dimensional head-mounted display system. Sequentially modified surgical techniques comprised puboprostatic open-collar technique, sutureless transection of the DVC, retrograde urethral dissection, and anterior reconstruction. The associations of these modifications with PSM and continence recovery were assessed. RESULTS: The puboprostatic open-collar technique, sutureless DVC transection, and retrograde urethral dissection were significantly associated with lower apical PSM (P = 0.003, 0.003, and 0.010, respectively). The former two also showed similar associations in 84 patients with anterior apical tumor (P = 0.021 and 0.030, respectively). Among 92 patients undergoing all of these three procedures, overall and apical PSM rates were 13.0% and 3.3%, respectively. Retrograde urethral dissection (odds ratio [OR] 2.73, P = 0.004) together with nerve sparing (OR 2.77, P = 0.003) and anterior apical tumor (OR 0.45, P = 0.017) were independently associated with immediate continence recovery. A multivariable model for 3-month continence recovery included anterior apical tumor (OR 0.28, P = 0.003) and puboprostatic open-collar technique (OR 3.42, P = 0.062). Immediate and 3-month continence recovery rates were 56.3% and 85.4%, respectively, in 103 patients undergoing both the puboprostatic open-collar technique and retrograde urethral dissection. CONCLUSION: Novel anatomical apical dissection utilizing a puboprostatic open-collar technique may favorably impact on both apical surgical margin and continence recovery. Public Library of Science 2021-04-15 /pmc/articles/PMC8049266/ /pubmed/33857230 http://dx.doi.org/10.1371/journal.pone.0249991 Text en © 2021 Koga et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Koga, Fumitaka Ito, Masaya Kataoka, Madoka Fukushima, Hiroshi Nakanishi, Yasukazu Takemura, Kosuke Suzuki, Hiroaki Sakamoto, Kazumasa Kobayashi, Shuichiro Tobisu, Ken-ichi Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery |
title | Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery |
title_full | Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery |
title_fullStr | Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery |
title_full_unstemmed | Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery |
title_short | Novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: Impact on apical surgical margin and early continence recovery |
title_sort | novel anatomical apical dissection utilizing puboprostatic “open-collar” technique: impact on apical surgical margin and early continence recovery |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049266/ https://www.ncbi.nlm.nih.gov/pubmed/33857230 http://dx.doi.org/10.1371/journal.pone.0249991 |
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