ArticleInternational braz j urol : official journal of the Brazilian Society of Urology
Transvesical Clipless Robot-Assisted Radical Prostatectomy Using a Multiport Plat-form: Technical Feasibility and Early Outcomes.
Article in International braz j urol : official journal of the Brazilian Society of Urology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionRobot-assisted radical prostatectomy (RARP) continues to evolve with surgical approaches aimed at preserving continence-related anatomy and optimizing postoperative recovery (1). Transvesical RARP has gained increasing interest, particularly with the advent of single-port platforms (2, 3). Building on our prior experience with clipless techniques and functional outcome optimization (4), we evaluated a multiport transvesical approach.
objectiveTo describe, step-by-step, a clipless transvesical RARP technique and to report its feasibility and early functional and oncologic outcomes. MATERIALS AND
methodsAn intravesical, line-of-sight technique was employed, with abdominal trocars positioned similarly to conventional transperitoneal RARP. The surgical sequence included: posterior release; longitudinal cystotomy with suspension sutures; semicircumferential bladder neck incision; bilateral clipless lateral dissection (blunt and sharp); anterior and apical release with dorsal venous complex control; urethral transection; urethrovesical anastomosis using two 3-0 barbed sutures; and single-layer cystotomy closure. Three consecutive patients with localized prostate cancer and moderate prostate volumes were included.
resultsAll procedures were completed as planned. Perioperative morbidity was low; one Clavien-Dindo grade II complication was managed conservatively. Early continence was observed in all patients, including at the first postoperative evaluation (45 days). One patient (Case 3) presented with a focal apical positive surgical margin on final pathology; prostate-specific antigen levels were undetectable in all cases during early follow-up. The approach was technically feasible and familiar to surgeons experienced in anterior RARP. Larger prostate volume may limit intravesical working space and apical visualization.
conclusionsWe describe a reproducible clipless transvesical RARP performed using a multiport platform, addressing a body of literature predominantly focused on single-port systems. The technique demonstrated encouraging early functional outcomes in carefully selected patients (5); however, larger prostate volumes and longer follow-up are required to further define its oncologic and functional durability. This video complements our previous publication on alternative RARP approaches supporting anterior-preserving strategies (6).
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