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Improved early and late continence following robot‐assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling)

Objective To describe a novel RoboSling technique performed at the time of robot‐assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively. Materials and Methods The surgical technique involves harvesting a vascularised, fascial flap from the perit...

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Published in:BJUI compass 2023-09, Vol.4 (5), p.597-604
Main Authors: Leslie, Scott, Jackson, Stuart, Broe, Mark, Diepen, Danielle C., Stanislaus, Christina, Steffens, Daniel, McClintock, George, Kim, Sia, Jeffery, Nicola, Fallot, Jeremy, Ahmadi, Nariman, Vasilaras, Arthur, Sved, Paul, Chan, Lewis, Thanigasalam, Ruban
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cited_by cdi_FETCH-LOGICAL-c5055-e353fb7e5025d02ed901d2ce29b8cd502d3b30a20168c33ed8c5d33118a7106a3
cites cdi_FETCH-LOGICAL-c5055-e353fb7e5025d02ed901d2ce29b8cd502d3b30a20168c33ed8c5d33118a7106a3
container_end_page 604
container_issue 5
container_start_page 597
container_title BJUI compass
container_volume 4
creator Leslie, Scott
Jackson, Stuart
Broe, Mark
Diepen, Danielle C.
Stanislaus, Christina
Steffens, Daniel
McClintock, George
Kim, Sia
Jeffery, Nicola
Fallot, Jeremy
Ahmadi, Nariman
Vasilaras, Arthur
Sved, Paul
Chan, Lewis
Thanigasalam, Ruban
description Objective To describe a novel RoboSling technique performed at the time of robot‐assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively. Materials and Methods The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes. Results The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT. Conclusions The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.
doi_str_mv 10.1002/bco2.225
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Materials and Methods The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes. Results The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT. Conclusions The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.</description><identifier>ISSN: 2688-4526</identifier><identifier>EISSN: 2688-4526</identifier><identifier>DOI: 10.1002/bco2.225</identifier><identifier>PMID: 37636210</identifier><language>eng</language><publisher>United States: John Wiley &amp; Sons, Inc</publisher><subject>Bladder ; Cancer surgery ; Catheters ; incontinence ; intraoperative sling ; Ligaments ; Lymphatic system ; Original ; Patients ; Prostate cancer ; prostatectomy ; Questionnaires ; Response rates ; robotic surgery ; Robotics ; Surgical techniques ; Sutures ; Urinary incontinence ; Urological surgery</subject><ispartof>BJUI compass, 2023-09, Vol.4 (5), p.597-604</ispartof><rights>2023 The Authors. published by John Wiley &amp; Sons Ltd on behalf of BJU International Company.</rights><rights>2023 The Authors. BJUI Compass published by John Wiley &amp; Sons Ltd on behalf of BJU International Company.</rights><rights>2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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Materials and Methods The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes. Results The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT. Conclusions The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. 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Jackson, Stuart ; Broe, Mark ; Diepen, Danielle C. ; Stanislaus, Christina ; Steffens, Daniel ; McClintock, George ; Kim, Sia ; Jeffery, Nicola ; Fallot, Jeremy ; Ahmadi, Nariman ; Vasilaras, Arthur ; Sved, Paul ; Chan, Lewis ; Thanigasalam, Ruban</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5055-e353fb7e5025d02ed901d2ce29b8cd502d3b30a20168c33ed8c5d33118a7106a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bladder</topic><topic>Cancer surgery</topic><topic>Catheters</topic><topic>incontinence</topic><topic>intraoperative sling</topic><topic>Ligaments</topic><topic>Lymphatic system</topic><topic>Original</topic><topic>Patients</topic><topic>Prostate cancer</topic><topic>prostatectomy</topic><topic>Questionnaires</topic><topic>Response rates</topic><topic>robotic surgery</topic><topic>Robotics</topic><topic>Surgical techniques</topic><topic>Sutures</topic><topic>Urinary incontinence</topic><topic>Urological surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leslie, Scott</creatorcontrib><creatorcontrib>Jackson, Stuart</creatorcontrib><creatorcontrib>Broe, Mark</creatorcontrib><creatorcontrib>Diepen, Danielle C.</creatorcontrib><creatorcontrib>Stanislaus, Christina</creatorcontrib><creatorcontrib>Steffens, Daniel</creatorcontrib><creatorcontrib>McClintock, George</creatorcontrib><creatorcontrib>Kim, Sia</creatorcontrib><creatorcontrib>Jeffery, Nicola</creatorcontrib><creatorcontrib>Fallot, Jeremy</creatorcontrib><creatorcontrib>Ahmadi, Nariman</creatorcontrib><creatorcontrib>Vasilaras, Arthur</creatorcontrib><creatorcontrib>Sved, Paul</creatorcontrib><creatorcontrib>Chan, Lewis</creatorcontrib><creatorcontrib>Thanigasalam, Ruban</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; 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Materials and Methods The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes. Results The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT. Conclusions The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.</abstract><cop>United States</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>37636210</pmid><doi>10.1002/bco2.225</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2459-8399</orcidid><orcidid>https://orcid.org/0000-0001-8727-5952</orcidid><orcidid>https://orcid.org/0000-0002-4835-7338</orcidid><orcidid>https://orcid.org/0000-0002-6992-8013</orcidid><orcidid>https://orcid.org/0000-0003-0777-6883</orcidid><oa>free_for_read</oa></addata></record>
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subjects Bladder
Cancer surgery
Catheters
incontinence
intraoperative sling
Ligaments
Lymphatic system
Original
Patients
Prostate cancer
prostatectomy
Questionnaires
Response rates
robotic surgery
Robotics
Surgical techniques
Sutures
Urinary incontinence
Urological surgery
title Improved early and late continence following robot‐assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling)
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