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The evolution and resurgence of perineal prostatectomy in the robotic surgical era

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Abstract

Purpose

To review the recent advances in terms of surgical technique and new robotic platforms applied to radical perineal prostatectomy (RPP).

Methods

A literature review was performed focusing on original articles on perineal prostatectomy searching via Medline/Pubmed and Embase. The entire spectrum was covered such as development of surgical technique including pelvic lymphadenectomy, adoption of novel surgical platforms, learning curve and future directions.

Results

Surgical removal of the prostate plays a significant role on the treatment of localized prostate cancer (PCa). RPP was the first surgical approach described for radical prostatectomy. This technique declined in popularity secondary to the development of the retropubic approach. Recently, the appearance of novel robotic technology has generated renewed interest in the perineal approach.

Conclusion

There has been a recent resurgence on the interest of radical perineal prostatectomy for the treatment of localized PCa driven by the advent of new robotic surgical technologies into the field. Future studies are needed to better determine the learning curve of the perineal approach and its current role in the treatment of prostate cancer.

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Author information

Authors and Affiliations

  1. Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA

    Juan Garisto, Riccardo Bertolo, Clark A. Wilson & Jihad Kaouk

Authors
  1. Juan Garisto
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  2. Riccardo Bertolo
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  3. Clark A. Wilson
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  4. Jihad Kaouk
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Contributions

JDG: project development, data collection, and manuscript writing. RB: data collection and manuscript writing. CAW: manuscript writing. JK: critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Jihad Kaouk.

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Conflict of interest

Jihad Kaouk certifies that all conflict of interest, including specific financial interest and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties or patents filed, received or pending), are the following: Jihad Kaouk is consulting research for Intuitive Surgical. The rest of the authors (Juan Garisto, Riccardo Bertolo, and Clark A. Wilson) have nothing to disclose.

Research involving human participants and/or animals

This article does not contain any experimental studies with human participants or animals performed by any of the authors.

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The individual re-identifiable pictures in this article were included with the informed consent of the patient.

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Supplement Figure 1.

Steps of Single port perineal prostatectomy: A) The posterior aspect of the Denonvilliers fascia identified and incised, B) left prostatic pedicles are clipped and divided, C) transection of the urethra and exposure of the Foley catheter, D) vesicourethral anastomosis, performed according to the Van Velthoven technique (JPEG 927 kb)

Supplement Figure 2.

Pelvic Lymph-Nodes Dissection by the single-port dedicated robotic platform (JPEG 742 kb)

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Garisto, J., Bertolo, R., Wilson, C.A. et al. The evolution and resurgence of perineal prostatectomy in the robotic surgical era. World J Urol 38, 821–828 (2020). https://doi.org/10.1007/s00345-019-03004-1

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  • DOI: https://doi.org/10.1007/s00345-019-03004-1

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