Retzius-Sparing Robotic Prostatectomy

What is Retzius-Sparing Robotic Prostatectomy (RS-RARP)?

Retzius-sparing Robotic Prostatectomy (RS-RARP) is a novel approach for treating prostate cancer by removal of the prostate gland. It is based off on conventional Robot-assisted laparoscopic radical prostatectomy (RARP) and has shown more advantages over RARP. In RS-RARP, the cave of Retzius containing fat and connective tissues is spared as well as the puboprostatic ligaments.

This preservation of more normal pelvic anatomy results in better continence outcome and reduce bladder neck descent.

Features and Benefits of Surgery

There are several advantages of RS-RARP over standard RARP. These include:

1. Improved continence (less leak) and potency – proven in multiple randomised controlled trials
2. No significant comprise in oncological outcomes (but cautious with anterior tumours, or large gland)
3. Potentially shorter procedure duration for experienced surgeons

Dr. Kim is a fellowship-trained surgeon and among the select few with specialised expertise in performing this advanced technique in Australia.

Preparation Before Surgery

In order to prepare for the surgery, the patient should be adequately counselled to ensure that the informed consent obtained is fully understood.

Dr Kim and his team then runs a number of tests to ensure that the patient is fit and in good health for the surgery. These will include thorough medical assessment (history, physical examination, investigations such as blood work, urine analysis, and various imaging scans if needed). If further work up is required Dr Kim’s team will arrange this and make the final call for eligibility based on the above information.

This is major surgery and patient is advised not to eat anything for six hours before the procedure.

Steps in Surgery

The robot used in this surgery is called the Da Vinci robot. Dr Kim may show the robot to the patient before the surgery in order to relieve any associated anxiety and answer any related questions.

The surgical procedures include the following steps:

• An IV line is passed into the patient’s arm to push fluids as needed.
• The anaesthetist sedates the patient and monitors his vitals during the procedure.
• The surgeon operates the robot from the adjacent room using controls.
• Keyhole incisions are made in the abdomen for the robotic arms and camera to allow the surgeon to see the internal view
• Once inside, the robot arms are manipulated to move various structures and organs out the way until the prostate gland is reached.
• The prostate tissue is dissected in sequence and bits and removed. The Retzius space is spared and as a result the bladder is not dropped down.
• The maximal length of the urethra will be spared to help with continence.
• The bladder and urethra are joined together and leak test is performed to ensure for watertight closure.
• A suprapubic catheter may be placed temporarily as part of the healing process in some cases.
• The robot extension and camera are removed and the initial incisions are sutured.
• The patient is brought out of anaesthesia and placed in post-operative care

Recovery After Surgery

The patient is kept in the recovery room for observation and their vitals are monitored. Pain relief (ie NSAIDs and paracetamol) are given for pain management.  The patient is shifted to a room in a few hours, and he can begin to take liquids by evening.

The patient can be discharged when they are able to move about, which usually happens in about two days on average. Recovery after surgery requires keeping the sutures clean and changing bandages as needed. Pain relief can also be taken on an as per need basis.

Dr Kim will normally arrange the catheter in the waterpipe to be removed in 7-10 day period.

The patients are also expected to return to light activities around the same time but to avoid heavy, strenuous activities up to 4-6 weeks after surgery.

Care plan

Dr Kim will devise a care plan for the patient and request follows up, several weeks apart. He will also request blood tests including PSA. His dedicate pelvic floor physiotherapists will ensure correct usage to enhance continence recovery. He will also offer several treatment options for some men who are interested in regaining sexual function.