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A Hybrid Approach To Hood-Sparing Robotic Prostatectomy To Maximize Functional Outcomes and Maintain Early Oncologic Efficacy.

BACKGROUND: We detail our approach and experience with a hybrid version of the endopelvic hood-sparing robotic-assisted radical prostatectomy (RARP) using the da Vinci robotic platform (Intuitive Surgical, Sunnyvale, CA).

MATERIALS AND METHODS: We retrospectively reviewed the records of 200 patients who underwent RARP by a single surgeon. Patients were propensity-matched into three cohorts depending on biopsy and prostatectomy Gleason Grade Groups: traditional retropubic (RP) (n=80), retzius-sparing (RS) (n=40), and hood-sparing (HS) (n=80). Patient characteristics, oncologic, and functional outcomes were examined. Zero pads per day defined return of continence. Erections suitable for penetrative intercourse with/without medications defined return of sexual function.

RESULTS: Patient characteristics were similar between cohorts excluding prostate specific antigen (PSA) levels (p=0.014), which were significantly lower in the RS cohort (7.1 +/- 5.3 ng/mL) compared to RP (9.2 +/- 9.3 ng/mL) and HS (8.8 +/- 8.9 ng/mL). Clinically significant positive margin rates (≥ 3millimeters or multifocal) were significantly higher (p=0.046) in the RS cohort (32.5%) compared to RP (17.5%) and HS (13.9%). Biochemical recurrence and metastasis rates were similar between all cohorts. Median time to continence was significantly lower for RS and HS-RARP (p<0.001) compared to RP-RARP at 1.3, 1.6, and 5.4 months, respectively. Median time to return of sexual function was significantly lower for RS and HS-RARP (p<0.001) compared to RP-RARP at 4.0, 7.7, and 15.1 months, respectively.

CONCLUSIONS: Our hybrid HS-RARP approach provides functional outcomes similar to RS-RARP with the early oncologic control of traditional RP-RARP.

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