Robotic-assisted radical prostatectomy(RARP) is widely used to surgically treat of localized prostate cancer. Among RARP, retzius-sparing techniques(Rs-RARP) are implemented through douglas pouch, not the existing conventional approach(C-RARP). 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 rsRARP 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 rsRARPs without tutoring, compared with 34 recently performed rsRARPs. 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 rsRARP, 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 rsRARP, respectively (P = 0.045).

Our analysis showed that RS-RARP is superior about early continence recovery than C-RARP. However, RS-RARP showed relatively high PSM in locally advanced PCa of pT3 or above. Therefore, although RS-RARP has few advantages about functional outcomes, we think that caution should be exercised when approaching patients with high-risk local diseases. The findings of this review indicate that RS-RALP may result in better continence outcomes than standard RALP up to 6 months after surgery. Continence outcomes at 12 months may be similar. The Retzius-sparing approach significantly reduces time to continence following RALP.

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 rsRARP. Surgeons should discuss these trade-offs and the limitations of the evidence with their patients when considering this approach.