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Robot-assisted laparoscopic radical prostatectomy
Posterior approach
Called
Retzius-sparing approach
08/02/2018 1Ch.F. Assenmacher
Challenging
• 10 years experience : conventional approach
• Functional & oncological results
– Comparable to the literature
08/02/2018 Ch.F. Assenmacher 2
•
•Jorge Fonseca,
•Head of department Urology,
•Champalimaud Fondation
08/02/2018 4Ch.F. Assenmacher
Learning curve
• Full time video (Aldo Bocciardi)
• Step by step
• 1° procedure 04/02/2017 (Belgium)
• 2° procedure same day
08/02/2018 Ch.F. Assenmacher 5
Functional results
• Better early continence
• Pad-free continence rate
X 5
08/02/2018 Ch.F. Assenmacher 7
Surgical margins
• Higher rates ??
• Unexpected location compared to conventional approach
• Less with experience
08/02/2018 Ch.F. Assenmacher 9
Moving or not ?
• Real benefit : functional results
• Bladder neck dissection
• Reduce surgical margin
08/02/2018 Ch.F. Assenmacher 10
• Dear colleagues, dear friends, • First of all I want the thank Dr Nelson Menezes
who invited me today for his 1st Symposium of oncologic Urology.
• I also want to thank my friend Jorge Fonseca and his fantastic team, without whom I would not be here today.
• I was asked to give you a little speech about a new technique without any scientific claim
• Just a few personal tips and comments
08/02/2018 23Ch.F. Assenmacher
Why ?
• Moving from a well standardised anterior approach to a new one was really challenging.
• From 11/2007 to 02/2017 I performed +-900 RARP with good oncological and functional results (compared to the literature)
08/02/2018 24Ch.F. Assenmacher
Why ?
• Thanks to Jorge Fonseca who lighted the fact that early continence was spectacularly better, he convince me to change the technique.
• He gave me a full time video of Aldo Bocciardi when performing his new technique at the “Challenges in Laparoscopy and Robotics” the 18 February 2016 at Champalimaud Foundation in Lisboa.
08/02/2018 25Ch.F. Assenmacher
Learning curve
• After having watched several times this excellent video and studying every surgical time, step by step, I decided to go on and perform my first case in 02/2017 in Belgium.
• This has been so satisfactory, that the second patient that day, previously planned for a conventional RARP, benefited also the Bocciardi technique.
08/02/2018 26Ch.F. Assenmacher
Functional results
• As our patient results come in and considering other published results using the technique, it’s becoming clear that this technique, known as a Retzius-sparing radical prostatectomy, is transforming patient results for continence and potency.
• That means that the pad-free continence rates are now more that 5 times better than they were before.
08/02/2018 27Ch.F. Assenmacher
What about surgical margins?
• When the technique was first described by Aldo Bocciardi, we could often hear, in the European urological community, that the main argument against the technique was the highest rates of surgical margins.
• I dare say, at the beginning, there were more SM on unexpected area. Especially anteriorly, between the Santoriny plexus and the prostate.
• With experiences, these SM occurred less and less frequently
08/02/2018 28Ch.F. Assenmacher
Mandatory to move ?
• In my mind, the patient benefits in terms of early continence and probably potency are significant.
• These arguments justify to spend time and energy in a better understanding and subsequently a better anatomical dissection of the bladder neck.
• This is the key point to reduce the SM rate, especially in its anterior part when posteriorly approached.
• The risk for SM in all other parts of the prostatic dissection (apical, basal, posterior, …) seems to be the same than by de conventional approach. No reason to be different!
08/02/2018 29Ch.F. Assenmacher