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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...

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Autores principales: Koga, Fumitaka, Ito, Masaya, Kataoka, Madoka, Fukushima, Hiroshi, Nakanishi, Yasukazu, Takemura, Kosuke, Suzuki, Hiroaki, Sakamoto, Kazumasa, Kobayashi, Shuichiro, Tobisu, Ken-ichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
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.
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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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