Laparoscopic radical prostatectomy is a challenging procedure that was mostly replaced by robotic assisted surgeries. A considerable number of difficult manoeuvres, and a technically challenge vesico-urethral anastomosis near the end, make it one of the most advanced laparoscopic surgeries in Urology[1]. The use of articulated devices, especially if robotic, is very attractive and can help the surgeon overcome these difficulties, achieving better results.
With this work we verified the impact in introducing those devices, not only in operation time, peri-operative features and results[2].

After introducing an articulated/robotic device (Dex Device™), and 10 surgeries performed by a single surgeon, we conducted a retrospective analysis of the pre-, intra-, and postoperative features comparing with the last 10 procedures done with straight laparoscopic instruments. To ensure the sample quality we also analysed some anthropometric and cancer-related features.

The patient related features analyses showed no statistically significant differences between the 2 groups, surgery without and with Dex Device™: age: 66,3 y vs 67,8 y, height: 172 cm vs 173 cm, weight: 80,4 kg vs 80,4 kg, prostate volume: 39,6 cc vs 46,6 cc and initial PSA: 10,25 ng/ml vs 15,15 ng/ml. The difference in operation time between the two groups was not statistically different (138 min vs 161 min, F = 3,34, p = 0,084) and the same was seen in length of hospital stay (3,1 days vs 2,7 days) and drainage duration (2,1 days vs 2,6 days). One-way ANOVA analysis of catheter duration showed a favourable result toward Dex Device™ utilisation (13,5 days vs 9,3 days, F = 10,3, p < 0,005). There were identified 2 Clavien-Dindo grade 3 complications in the former group (vesico-urethral anastomosis stenosis) and 2 Clavien-Dindo grade 2, one in each group (vesical urgency). The positive surgical margins (PSM) analyse showed a tendency to positive margins in our study group, although not statistically significant (p = 0,057). There’s also a tendency to higher Gleason scores and initial PSA that could explain this tendency. All patients were pad free at 3 months and 90% after the first month.

Our results revealed no statistical difference between both groups in terms of surgery duration and immediately end results. Both populations showed no major differences in terms of age, prostate volume or cancer aggressiveness. When we analyse PSM and continence results (using a very objective pad free metric), the two most objective trifecta features, we obtain no differences and a tendency for an early continence recover. This tendency was also seen in our dally practice and we think is mostly due to a better technically anastomosis and a consequent increase in surgeons’ confidence.

This is the first study comparing these devices and looking at the learning curve impact of these technologies and we concluded that introducing an articulated/robotic device in laparoscopic radical prostatectomy, by an experienced team, will not affect the duration, complications, or PSM results. In fact, the authors believe that this device can help with difficult cases (very high-risk patients) and could have an impact in early continence by allowing a more effective anastomosis.

Varca V, Benelli A, Pietrantuono F, Suardi N, Gregori A, Gaboardi F. A Robotic Needle Driver to Facilitate Vescico-Urethral Anastomosis during Laparoscopic Radical Prostatectomy. Urol J. 2017;84(4):259-26doi:10.5301/uj.5000245
Varca V, Benelli A, Pietrantuono F, Suardi N, Gregori A, Gaboardi F. A Robotic Needle Driver to Facilitate Vescico-Urethral Anastomosis during Laparoscopic Radical Prostatectomy. Urol J. 2017;84(4):259-26doi:10.5301/uj.500024Madec FX, Dariane C, Cornu JN. Evaluation and comparison of basic gestures in ex vivo laparoscopic surgery using a robotic instrument and traditional laparoscopic instruments. Prog En Urol. 2020;30(1):58-6doi:10.1016/j.purol.2019.11.005