Open Anterograde Anatomic Radical Prostatectomy: a technique developed at Rio de Janeiro State University

Abstract

Introduction: Radical prostatectomy is the gold standard treatment for localized prostate cancer, videolaparoscopic prostatectomy was a new leap forward, however, it added great technical difficulty with long and very slow learning curve overcome by few and very skilled surgeons, which made the universalization of the technique extremely difficult. Robotic-assisted laparoscopic surgery democratized laparoscopic radical prostatectomy, allowing a large number of surgeons, even the least experienced, to perform this procedure with the same technique as experienced surgeons. However, the high cost of this technology greatly limits universalization, especially in countries in the global south. Methodology: In 2015, the possibility of using some concepts from laparoscopic prostatectomy to improve open prostatectomy was discussed. Based on a study of the various techniques performed by open, laparoscopic and robotic route, we developed a novel technique to reproduce robotic prostatectomy openly, without the addition of any new instrument or special materials and call "Open Anterograde Anatomic Radical Retropubic Prostatectomy" (AORP). Results: AORP was superior to Open Radical Prostatectomy in critical parameters that the median estimated blood loss 300mL versus 500mL (p=0.0003), urethrovesical anastomosis more rapid 20min versus 25min (p=0.005), shorter duration of indwelling vesical catheterization 7 versus 14 days, the surgeon's perception of the nerve-sparing 101 (87.8%) and 71 (67.6%) (p=0.0009), urinary continence 70 (60.9%) versus 45 (42.0%), fewer complications (p=0.007) and similar oncological control. Discussion: we understand that the gains of robotic surgery are not only due to the introduction of technology but also to an improvement in the technique of dissection, preservation and reconstruction that can be reproduced in open surgery and allow patients without access to robotic technology to be similarly operated with an improved procedure.