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 was a new leap forward, however, it added great technical difficulty, long and very slow learning curve overcome by few and surgeons, which made the universalization extremely difficult. Robotic prostatectomy democratized this surgery, allowing a large number of surgeons to perform this procedure. 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 and 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 materials "Open Anterograde Anatomic Radical Retropubic Prostatectomy" (AORP). RESULTS: AORP was superior to Open Radical Prostatectomy in critical parameters: median estimated blood loss 300mL versus 500mL (p=0.0003), urethrovesical anastomosis 20min versus 25min (p=0.005), shorter duration of indwelling vesical catheterization 7 versus 14 days, 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.