OpenLB
Open Library of Bioscience
Advanced Search
Journal of robotic surgery
Dec, 2021;15 (6): 829-839.

Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus.

Eliney Ferreira Faria, Carlos Vaz Melo Maciel, André Berger, Anuar Mitre, Breno Dauster, Celso Heitor Freitas, Clovis Fraga, Daher Chade, Marcos Dall'Oglio, Francisco Carvalho, Franz Campos, Gustavo Franco Carvalhal, Gustavo Caserta Lemos, Gustavo Guimarães, Hamilton Zampolli, Joao Ricardo Alves, Joao Pádua Manzano, Marco Antônio Fortes, Marcos Flavio Holanda Rocha, Mauricio Rubinstein, Murilo Luz, Pedro Romanelli, Rafael Coelho, Raphael Rocha, Roberto Dias Machado, Rodolfo Borges Dos Reis, Stenio Zequi, Romulo Guida, Valdair Muglia, Marcos Tobias-Machado
Author Information
  1. Eliney Ferreira Faria: Hospital Felicio Rocho, Belo Horizonte, MG, Brazil. elineyferreirafaria@yahoo.com.br.
  2. Carlos Vaz Melo Maciel: Hospital Felicio Rocho, Belo Horizonte, MG, Brazil.
  3. André Berger: Hospital Moinhos de Vento, Porto Alegre , RS, Brazil.
  4. Anuar Mitre: University of São Paulo, São Paulo, SP, Brazil.
  5. Breno Dauster: Hospital Aristides Maltez, Salvador, BA, Brazil.
  6. Celso Heitor Freitas: Hospital Benefiencia Portuguesa, São Paulo, SP, Brazil.
  7. Clovis Fraga: Hospital Real Portugues, Recife, PE, Brazil.
  8. Daher Chade: Instituto Cancer de São Paulo, São Paulo, SP, Brazil.
  9. Marcos Dall'Oglio: University of São Paulo, São Paulo, SP, Brazil.
  10. Francisco Carvalho: Hospital Porto Dias, Belem, PA, Brazil.
  11. Franz Campos: Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil.
  12. Gustavo Franco Carvalhal: Hospital Moinhos de Vento, Porto Alegre , RS, Brazil.
  13. Gustavo Caserta Lemos: Hospital Albert Einstein, São Paulo, SP, Brazil.
  14. Gustavo Guimarães: Hospital Benefiencia Portuguesa, São Paulo, SP, Brazil.
  15. Hamilton Zampolli: Instituto do Cancer, São Paulo, SP, Brazil.
  16. Joao Ricardo Alves: Hospital de Base de Brasilia, Brasilia, DF, Brazil.
  17. Joao Pádua Manzano: Hospital Moriah, São Paulo, SP, Brazil.
  18. Marco Antônio Fortes: Instituto Dor, Rio de Janeiro, RJ, Brazil.
  19. Marcos Flavio Holanda Rocha: Hospital Monte Klinikun, Fortaleza, CE, Brazil.
  20. Mauricio Rubinstein: University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
  21. Murilo Luz: Hospital Albert Einstein, São Paulo, SP, Brazil.
  22. Pedro Romanelli: Hospital Felício Rocho, Belo Horizonte, MG, Brazil.
  23. Rafael Coelho: Instituto Cancer de São Paulo, São Paulo, SP, Brazil.
  24. Raphael Rocha: Hospital Americas, Rio de Janeiro, RJ, Brazil.
  25. Roberto Dias Machado: Hospital de Cancer de Barretos, Barretos, SP, Brazil.
  26. Rodolfo Borges Dos Reis: University of São Paulo, Ribeirão Preto, SP, Brazil.
  27. Stenio Zequi: AC Camargo, São Paulo, SP, Brazil.
  28. Romulo Guida: Hospital Quinta Dor, Rio de Janeiro, RJ, Brazil.
  29. Valdair Muglia: University of São Paulo, Ribeirão Preto, SP, Brazil.
  30. Marcos Tobias-Machado: Faculdade de Medcina ABC, São Paulo, SP, Brazil.
PMID: 33426578 DOI: 10.1007/s11701-020-01186-0

Abstract

Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.

Keywords

Experts Prostate cancer Robotic-assisted radical prostatectomy

References

Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M et al (2012) Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 62(3):382–404 [PMID: 22749851]
Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y et al (2018) Robot-assisted radical prostatectomy is more beneficial for prostate cancer patients: a system review and meta-analysis. Med Sci Monit 24:272–287 [PMID: 29332100]
Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR et al (2012) Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 62(3):368–381 [PMID: 22763081]
Ficarra V, Wiklund PN, Rochat CH, Dasgupta P, Challacombe BJ, Sooriakumaran P et al (2013) The european association of urology robotic urology section (ERUS) survey of robot-assisted radical prostatectomy (RARP). BJU Int 111(4):596–603 [PMID: 23551442]
Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M (2007) Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev 9:CD009625
Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417 [PMID: 22749852]
Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M et al (2012) Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 62(3):418–430 [PMID: 22749850]
Preisser F, Nazzani S, Mazzone E, Knipper S, Bandini M, Tian Z et al (2019) Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States. World J Urol 37(7):1305–1313 [PMID: 30315358]
Fink A, Kosecoff J, Chassin M, Brook RH (1984) Consensus methods: characteristics and guidelines for use. Am J Public Health 74(9):979–983 [PMID: 6380323]
https://www.inca.gov.br/numeros-de-cancer . Accessed 10 March 2020
https://portaldaurologia.org.br/medicos/noticias/nota-oficial-sbu-e-sbpc-ml-rastreio-de-cancer-de-prostata/ . Accessed 5 July 2020
Moldovan PC, Van den Broeck T, Sylvester R, Marconi L, Bellmunt J, van den Bergh RCN et al (2017) What Is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? A systematic review and meta-analysis from the European association of urology prostate cancer guidelines panel. Eur Urol 72(2):250–266 [PMID: 28336078]
Lightner DJ, Wymer K, Sanchez J, Kavoussi L (2020) Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 203(2):351–356 [PMID: 31441676]
Semerjian A, Pavlovich CP (2017) Extraperitoneal robot-assisted radical prostatectomy: indications, technique and outcomes. Curr Urol Rep 18(6):42 [PMID: 28417427]
Lee JY, Diaz RR, Cho KS, Choi YD (2013) Meta-analysis of transperitoneal versus extraperitoneal robot-assisted radical prostatectomy for prostate cancer. J Laparoendosc Adv Surg Tech A 23(11):919–925 [PMID: 24083848]
Chauhan S, Coelho RF, Rocco B, Palmer KJ, Orvieto MA, Patel VR (2010) Techniques of nerve-sparing and potency outcomes following robot-assisted laparoscopic prostatectomy. Int Braz J Urol 36(3):259–272 [PMID: 20602818]
Pisipati S, Ali A, Mandalapu RS, Haines Iii GK, Singhal P, Reddy BN et al (2014) Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy. Indian J Urol 30(4):399–409 [PMID: 25378822]
Schatloff O, Chauhan S, Sivaraman A, Kameh D, Palmer KJ, Patel VR (2012) Anatomic grading of nerve sparing during robot-assisted radical prostatectomy. Eur Urol 61(4):796–802 [PMID: 22230713]
Jaderling F, Akre O, Aly M, Bjorklund J, Olsson M, Adding C et al (2019) Preoperative staging using magnetic resonance imaging and risk of positive surgical margins after prostate-cancer surgery. Prostate Cancer Prostatic Dis 22(3):391–398 [PMID: 30504811]
Tewari AK, Srivastava A, Huang MW, Robinson BD, Shevchuk MM, Durand M et al (2011) Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int 108(6 Pt 2):984–992 [PMID: 21917101]
Goonewardene SS, Gillatt D, Persad R (2018) A systematic review of PFE pre-prostatectomy. J Robot Surg 12(3):397–400 [PMID: 29564692]
Fernandez RA, Garcia-Hermoso A, Solera-Martinez M, Correa MT, Morales AF, Martinez-Vizcaino V (2015) Improvement of continence rate with pelvic floor muscle training post-prostatectomy: a meta-analysis of randomized controlled trials. Urol Int 94(2):125–132 [PMID: 25427689]
Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M (2013) Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial. J Urol 189(3):891–898 [PMID: 23017512]
Patel VR, Coelho RF, Palmer KJ, Rocco B (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56(3):472–478 [PMID: 19560260]
Rocco F, Gadda F, Acquati P, Carmignani L, Favini P, Dell’Orto P et al (2001) Personal research: reconstruction of the urethral striated sphincter. Arch Ital Urol Androl 73(3):127–137 [PMID: 11822054]
Coelho RF, Chauhan S, Orvieto MA, Sivaraman A, Palmer KJ, Coughlin G et al (2011) Influence of modified posterior reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol 59(1):72–80 [PMID: 20801579]
Rocco B, Cozzi G, Spinelli MG, Coelho RF, Patel VR, Tewari A et al (2012) Posterior musculofascial reconstruction after radical prostatectomy: a systematic review of the literature. Eur Urol 62(5):779–790 [PMID: 22664219]
Stolzenburg JU, Liatsikos EN, Rabenalt R, Do M, Sakelaropoulos G, Horn LC et al (2006) Nerve sparing endoscopic extraperitoneal radical prostatectomy–effect of puboprostatic ligament preservation on early continence and positive margins. Eur Urol 49(1):103–111 (discussion 11-2) [PMID: 16314031]
Hurtes X, Roupret M, Vaessen C, Pereira H, Faivre d’Arcier B, Cormier L et al (2012) Anterior suspension combined with posterior reconstruction during robot-assisted laparoscopic prostatectomy improves early return of urinary continence: a prospective randomized multicentre trial. BJU Int 110(6):875–883 [PMID: 22260307]
Student V Jr, Vidlar A, Grepl M, Hartmann I, Buresova E, Student V (2017) Advanced reconstruction of vesicourethral support (ARVUS) during robot-assisted radical prostatectomy: one-year functional outcomes in a two-group randomised controlled trial. Eur Urol 71(5):822–830 [PMID: 27283216]
Wu YP, Xu N, Wang ST, Chen SH, Lin YZ, Li XD et al (2017) The efficacy and feasibility of total reconstruction versus nontotal reconstruction of the pelvic floor on short-term and long-term urinary continence rates after radical prostatectomy: a meta-analysis. World J Surg Oncol 15(1):228 [PMID: 29262863]
Lin D, O’Callaghan M, David R, Fuller A, Wells R, Sutherland P et al (2020) Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)? BMC Urol 20(1):8 [PMID: 32005113]
Li H, Liu C, Zhang H, Xu W, Liu J, Chen Y et al (2015) The use of unidirectional barbed suture for urethrovesical anastomosis during robot-assisted radical prostatectomy: a systematic review and meta-analysis of efficacy and safety. PLoS ONE 10(7):e0131167 [PMID: 26135310]
Nyarangi-Dix JN, Tichy D, Hatiboglu G, Pahernik S, Tosev G, Hohenfellner M (2018) Complete bladder neck preservation promotes long-term post-prostatectomy continence without compromising midterm oncological outcome: analysis of a randomised controlled cohort. World J Urol 36(3):349–355 [PMID: 29214353]
Ma X, Tang K, Yang C, Wu G, Xu N, Wang M et al (2016) Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis. Oncotarget 7(41):67463–67475 [PMID: 27634899]
Bellangino M, Verrill C, Leslie T, Bell RW, Hamdy FC, Lamb AD (2017) Systematic review of studies reporting positive surgical margins after bladder neck sparing radical prostatectomy. Curr Urol Rep 18(12):99 [PMID: 29116405]
Lee Z, Sehgal SS, Graves RV, Su YK, Llukani E, Monahan K et al (2014) Functional and oncologic outcomes of graded bladder neck preservation during robot-assisted radical prostatectomy. J Endourol 28(1):48–55 [PMID: 23980532]
Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M et al (2013) Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with >/= 1 year of follow-up. Eur Urol 64(6):974–980 [PMID: 23856036]
Dalela D, Jeong W, Prasad MA, Sood A, Abdollah F, Diaz M et al (2017) A pragmatic randomized controlled trial examining the impact of the retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 72(5):677–685 [PMID: 28483330]
Porcaro AB, Siracusano S, Bizzotto L, Sebben M, Cacciamani GE, de Luyk N, et al. (2019) Is a drain needed after robotic radical prostatectomy with or without pelvic lymph node dissection? Results of a single-center randomized clinical trial. J Endourol https://doi.org/10.1089/end.2018.0176
Chenam A, Yuh B, Zhumkhawala A, Ruel N, Chu W, Lau C et al (2018) Prospective randomised non-inferiority trial of pelvic drain placement vs no pelvic drain placement after robot-assisted radical prostatectomy. BJU Int 121(3):357–364 [PMID: 28872774]
Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH et al (2010) Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol 183(6):2213–2218 [PMID: 20399459]
Jaulim A, Srinivasan A, Hori S, Kumar N, Warren AY, Shah NC et al (2018) A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice. Ann R Coll Surg Engl 100(3):226–229 [PMID: 29484935]
Seo HJ, Lee NR, Son SK, Kim DK, Rha KH, Lee SH (2016) Comparison of robot-assisted radical prostatectomy and open radical prostatectomy outcomes: a systematic review and meta-analysis. Yonsei Med J 57(5):1165–1177 [PMID: 27401648]
Huang X, Wang L, Zheng X, Wang X (2017) Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc 31(3):1045–1060 [PMID: 27444830]
Wang L, Wang B, Ai Q, Zhang Y, Lv X, Li H et al (2017) Long-term cancer control outcomes of robot-assisted radical prostatectomy for prostate cancer treatment: a meta-analysis. Int Urol Nephrol 49(6):995–1005 [PMID: 28238148]
Sivaraman A, Sanchez-Salas R, Prapotnich D, Yu K, Olivier F, Secin FP et al (2017) Learning curve of minimally invasive radical prostatectomy: comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 35(4):149 (e1–e6) [PMID: 28117215]
Gumus E, Boylu U, Turan T, Onol FF (2011) The learning curve of robot-assisted radical prostatectomy. J Endourol 25(10):1633–1637 [PMID: 21815823]
Mikhail AA, Stockton BR, Orvieto MA, Chien GW, Gong EM, Zorn KC et al (2006) Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology 67(4):774–779 [PMID: 16566979]
Abdul-Muhsin H, Giedelman C, Samavedi S, Schatloff O, Coelho R, Rocco B et al (2014) Perioperative and early oncological outcomes after robot-assisted radical prostatectomy (RARP) in morbidly obese patients: a propensity score-matched study. BJU Int 113(1):84–91 [PMID: 23461310]
Kumar A, Samavedi S, Bates AS, Coelho RF, Rocco B, Palmer K et al (2015) Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors. BJU Int 116(5):764–770 [PMID: 25726729]
Kaler K, Vernez SL, Dolich M (2016) Minimally invasive hernia repair in robot-assisted radical prostatectomy. J Endourol 30(10):1036–1040 [PMID: 27575356]
Link BA, Nelson R, Josephson DY, Yoshida JS, Crocitto LE, Kawachi MH et al (2008) The impact of prostate gland weight in robot assisted laparoscopic radical prostatectomy. J Urol 180(3):928–932 [PMID: 18635217]
Levinson AW, Ward NT, Sulman A, Mettee LZ, Link RE, Su LM et al (2009) The impact of prostate size on perioperative outcomes in a large laparoscopic radical prostatectomy series. J Endourol 23(1):147–152 [PMID: 19125654]
Fossati N, Parker WP, Karnes RJ, Colicchia M, Bossi A, Seisen T et al (2018) More extensive lymph node dissection at radical prostatectomy is associated with improved outcomes with salvage radiotherapy for rising prostate-specific antigen after surgery: a long-term. Multi-institutional Analysis Eur Urol 74(2):134–137 [PMID: 29544737]
Fossati N, Suardi N, Gandaglia G, Bravi CA, Soligo M, Karnes RJ et al (2019) Identifying the optimal candidate for salvage lymph node dissection for nodal recurrence of prostate cancer: results from a large. Multi-institutional Analysis Eur Urol 75(1):176–183 [PMID: 30301694]
Preisser F, Bandini M, Marchioni M, Nazzani S, Tian Z, Pompe RS et al (2018) Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. Prostate 78(6):469–475 [PMID: 29460290]
Altok M, Babaian K, Achim MF, Achim GC, Troncoso P, Matin SF et al (2018) Surgeon-led prostate cancer lymph node staging: pathological outcomes stratified by robot-assisted dissection templates and patient selection. BJU Int 122(1):66–75 [PMID: 29446205]
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N et al (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61(3):480–487 [PMID: 22078338]
Mattei A, Di Pierro GB, Grande P, Beutler J, Danuser H (2013) Standardized and simplified extended pelvic lymph node dissection during robot-assisted radical prostatectomy: the monoblock technique. Urology 81(2):446–450 [PMID: 23374827]
Zorn KC, Katz MH, Bernstein A, Shikanov SA, Brendler CB, Zagaja GP et al (2009) Pelvic lymphadenectomy during robot-assisted radical prostatectomy: assessing nodal yield, perioperative outcomes, and complications. Urology 74(2):296–302 [PMID: 19515403]
Secin FP, Jiborn T, Bjartell AS, Fournier G, Salomon L, Abbou CC et al (2008) Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 53(1):134–145 [PMID: 17597288]

MeSH Term

Consensus
Humans
Male
Practice Guidelines as Topic
Prostate
Prostatectomy
Prostatic Neoplasms
Robotic Surgical Procedures
Treatment Outcome
Journal Article Consensus Development Conference

Word Cloud

Similar Articles

Cited By