The early selective dorsal vein complex (DVC) ligation technique with puboprostatic ligament (PPL) preservation aims at selective suturing of DVC by preserving PPL and, consecutively, the External urethral sphincter complex to improve functional outcomes in robot-assisted laparoscopic radical prostatectomy (RALP) by preserving part of the external urethral sphincter (EUS) complex and ensuring a secure knot on the DVC. This reduces the risk of bleeding and improves continence. This study evaluates the feasibility and outcomes of this modified technique.

In the Puboprostatic sparing DVC ligation technique, the initial throw commenced from the midpoint of the PPL, passing anteriorly across the DVC complex. Then, the same suture is passed posteriorly across the DVC and returned to the entry point while sparing the PPL. The advantage of this technique is that it is a secure stitch, which gives good hemostasis and preserves PPL, which could be anchored after vesicourethral anastomosis. Apical dissection and the other standard steps of nerve-sparing RALP were performed. In our study, between 2017-22, a cohort of 373 patients underwent RALP using this technique. We evaluated the blood loss, 3-month, and 12-month continence rates.

The mean age of the patients who underwent RALP was 65.3 years. The mean operative time was 168.4(±28.3) minutes, with an average blood loss of 76.4(±49.2) cc. Postoperatively, 83.1% (n=310) of patients were continent at 3 months, and 96.8% (n=361) of patients were continent at the 12-month follow-up. 85.3% of patients underwent nerve-sparing RALP. No intraoperative complications were reported.

The early modified DVC ligation technique in RARP is safe and feasible. It demonstrates hemostasis with a secure stitch and promising functional outcomes, including a high early continence rate at 3 months and potentially improved continence recovery, with no reported intraoperative complications.