Retzius sparing robot-assisted radical prostatectomy (RS-RARP) is increasingly being used, but results of pertinent studies on perioperative, functional, and oncological outcomes comparing the Retzius sparing approach with standard robot-assisted radical prostatectomy (RARP) remain inconsistent. Retzius -sparing robot-assisted radical prostatectomy (RS-RARP) is generally known to have a positive effect on early continence recovery. The Retzius-sparing approach allows entire prostatectomy procedure via the pouch of Douglas. It is difficult to expect a fast learning curve due to the limitation of the surgical space.

A single surgeon had performed more than 1,100 open radical prostatectomies (ORP), since 2004. The surgeon started performing RARP with RS-RARP in 2020. We evaluated perioperative (operation time, estimated blood loss, hospital stay, pathological stage, Gleason score, and margin status) and postoperative (continence and erectile dysfunction) parameters in initial 30 cases of RS-RARPs without tutoring, compared with 34 recently performed RS-RARPs. This study was analyzed using data prospectively entered into the research registry.

Median operation time and length of hospital stay for initial versus recent rsRARP were 288 minutes versus 193 minutes (P = 0.004), and 8 days versus 7 days (P = 0.120), respectively. There was no significant difference in estimated blood loss, pathological stage, and Gleason score between the two groups. Positive surgical margins were seen in 26.7% versus 8.8% of cases in initial versus recent RS-RARP, respectively (P = 0.059), showing a marginal statistical difference. At postoperative 3 months, there was no difference in the decrease in IIEF-5 score between the two groups. But pad-free continence including the use of a security pad was reported in 76.7% versus 94.1% in patients with initial versus recent RS-RARP, respectively (P = 0.045).

Available data suggest a statistically significant advantage in favor of RS-RARP in terms of immediate urinary continence recovery. Our meta-analysis of the current evidence shows a significant advantage for Retzius sparing robot-assisted radical prostatectomy (RS-RARP) over robot-assisted radical prostatectomy in terms of immediate urinary continence recovery, There was no significant difference in the preservation of erectile function and overall postoperative complication rates between both the techniques.

In terms of the operation time and postoperative urinary continence, the recent surgeries showed better results than the initial experiences. Previous large-volume experience of ORPs may shorten the learning curve for RS-RARP.  RS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL. Retzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control.