Carbin Danny Darlington, Antonoglou Georgios, Harmouche Celine, Abou Chedid Wissam
Department of Urology, Royal Surrey County Hospital, Guildford, GU2 7XX, UK.
Department of Radiology, Ashford and St.Peters NHS Foundation Trust, Chertsey, UK.
J Robot Surg. 2025 Apr 9;19(1):141. doi: 10.1007/s11701-025-02321-5.
Retzius-sparing RARP (RS-RARP) is a modification of the standard RARP technique that traditionally requires clips to control the pedicles. We aimed to retrospectively analyze the operative, oncological, and functional outcomes of this altogether 'clipless' approach to RS-RARP from our centre. The study was conducted as a retrospective audit in our department. We included consecutive patients who underwent clipless-RS-RARP in our centre from February 2023 to December 2023. The clipless RS-RARP was done with the daVinci Xi system in all cases (primary surgeon-author WAC). No clips were used in these procedures and the preoperative, intra-operative, and postoperative data were recorded with at least 3 months of follow-up. Continence was defined as zero pad usage. A total of 138 patients underwent RS-RAP using the clipless technique during the study period. The median age was 64 years, with a median BMI of 27.25 kg/m. 88.41% were ISUP 1-3 group patients. 82.61% were cT2, 17.39% were cT3, and 13.77% had median lobe in MRI. The mean console time was 99 min, with 81.16% having bilateral nerve spare, 17.39% unilateral spare, and 1.45% having none. 38.41% were fit to be discharged on the same day/evening of admission/surgery. There were no major complications (Clavien-Dindo [CD] ≥ 3) or postoperative bleeding. The margin positivity rate was 19.50%, of which 62.95% were stage ≥ pT3a. The continence rates were 86.2% at 6 weeks 89.1% at 3 months and 93.4% at 6 months. The potency and biochemical recurrence rates were 79% and 3.6%, respectively, at 6 months.Clipless RS-RARP is a safe procedure with good oncological and early continence recovery. This modification avoids clip-related complications without the expense of any higher complication rates compared to a standard RARP.
保留Retzius间隙的机器人辅助根治性前列腺切除术（RS-RARP）是对标准RARP技术的一种改良，传统的标准RARP技术需要使用夹子来控制血管蒂。我们旨在回顾性分析我们中心采用这种完全“无夹”方法进行RS-RARP的手术、肿瘤学和功能结果。该研究在我们科室进行回顾性审计。我们纳入了2023年2月至2023年12月在我们中心接受无夹RS-RARP的连续患者。所有病例均使用达芬奇Xi系统进行无夹RS-RARP（主刀医生为本文作者WAC）。这些手术中未使用夹子，并记录了术前、术中及术后数据，随访至少3个月。控尿定义为无需使用尿垫。在研究期间，共有138例患者采用无夹技术接受了RS-RAP。中位年龄为64岁，中位体重指数为27.25kg/m²。88.41%为国际泌尿病理学会（ISUP）1-3组患者。82.61%为cT2期，17.39%为cT3期，13.77%在MRI检查中有中叶受累。平均控制台操作时间为99分钟，81.16%的患者保留双侧神经，17.39%保留单侧神经，1.45%未保留神经。38.41%的患者适合在入院/手术后当天/当晚出院。无重大并发症（Clavien-Dindo[CD]≥3级）或术后出血。切缘阳性率为19.50%，其中62.95%为≥pT3a期。6周时控尿率为86.2%，3个月时为89.1%，6个月时为93.4%。6个月时性功能恢复率和生化复发率分别为79%和3.6%。无夹RS-RARP是一种安全的手术，具有良好的肿瘤学效果和早期控尿恢复。与标准RARP相比，这种改良避免了与夹子相关的并发症，且不会增加任何更高的并发症发生率。
