Evaluation of the efficacy of robot-assisted laparoscopic radical prostatectomy with modified anterior approach and retention of Retzius space

Objective: To evaluate the curative effect of robot-assisted laparoscopic radical prostatectomy with partial Retzius space preservation through the anterior approach. Methods: The clinical data of 41 patients with prostate cancer were retrospectively analyzed.According to the operation method, the patients were divided into theh robot-assisted laparoscopic radical prostatectomy(MARS-RARP) group(20 cases) and robot-assisted laparoscopic radical prostatectomy(RARP) group(21 cases).The surgical improvements in MARS-RARP group included preserving bilateral pelvic fascia, no disconnecting puboprostatic ligament, no suturing dorsal deep vein complex, no opening bladder peritoneal reflexes and umbilical median and internal ligaments.The perioperative data and postoperative follow-up data between two groups were compared. Results: All 41 operations were successfully completed, with no cases of conversion to open surgery or change of surgical methods.There was no statistical significance in the operation time and intraoperative blood loss between two groups(P>0.05).The incidence of postoperative complications in the MARS-RARP group was lower than that in RARP group(P < 0.05).The recovery time of postoperative urinary control in the MARS-RARP group was shorter than that in RARP group, the recovery rates of erectile function at 1 and 2 months in the MARS-RARP group were higher than those in RARP group(P < 0.05).There was no statistical significance in the recovery rate at 3 months between two groups(P>0.05).No positive resection margins were found in two groups after operation.During the 3-month of follow-up, the prostate-specific antigen of patients was < 0.2 ng/mL. Conclusions: MARS-RARP is safe and effective.It can promote early urinary control and erectile function recovery, and prevent the occurrence of surgery-related intestinal obstruction and inguinal hernia by preserving the anatomical structure around the urethra, preserving the complete retroflexion of bladder peritoneum, median umbilical ligament and paraumbilical ligament, and restoring peritoneal integrity.