Retrograde Robotic Radical Prostatectomy: Description of a New Technique and Early Perioperative Outcomes

Objectives. This research was conducted to describe a novel technique for performing robotic-assisted laparoscopic prostatectomy (RALP) using a retrograde approach that mimics the classic open surgical technique. Methods. From June 2009 to March 2011, we performed 18 nonconsecutive RALPs using a novel retrograde approach. Patients were initially selected with D’Amico low to intermediate risk disease. Pre-, intra-, and postoperative data were analyzed in all patients. Results. All 18 patients had successful surgery without any intraoperative complications. Mean preoperative PSA was 6.0？ng/mL. Nine patients had biopsy Gleason score (GS) 6, seven patients had GS 7, and two patients had GS 8. Fourteen patients had clinical stage T1c and four patients had stage T2a. Mean operative time was 198 minutes, with a mean robotic console time of 168 minutes. Fifteen patients had T2 disease on the final pathology and three had T3 disease. With a median follow-up of 11 months, 10 patients had an undetectable PSA. Conclusions. Our early experience with retrograde robotic-assisted laparoscopic prostatectomy demonstrates the feasibility of this approach with early outcomes comparable to the contemporary antegrade approach. Long-term study with a greater number of patients will be necessary to fully evaluate the oncologic and functional outcomes using this technique. 1. Introduction Following the initial description of robotic-assisted laparoscopic prostatectomy (RALP) in 2001 [1], this procedure is now the most common surgical procedure performed in the United States for treatment of localized prostate cancer [2]. The advantages of RALP over the classical open radical retropubic prostatectomy (RRP) approach include decreased operative blood loss, decreased need of analgesics, earlier convalescence, and superior cosmesis [3, 4]. Among the various challenges facing the surgeon interested in adopting the robotic approach is the alteration in surgical technique required to perform RALP successfully. This adaptation may be of minimal significance to urology residents and fellows exposed and trained in minimally invasive techniques; however, it may be an obstacle for surgeons who have performed open RRP for years and desire learning the robotic technique. One of the major differences between the technique currently used for RALP and the open RRP is the direction of prostate dissection. Contemporary RALP has adopted the original laparoscopic approach as described by Guillonneau and Vallancien [5]. Using this technique of antegrade dissection, the prostate is initially incised