Technical aspects of robot-assisted Retzius-sparing radical prostatectomy and perioperative outcomes of an initial case series

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Background . Retzius-sparing robot-assisted radical prostatectomy is a modification of robot-assisted radical prostatectomy in which the prostate is removed through a posterior approach without entering the cave of Retzius. This technique is aimed at preserving the puboprostatic ligaments, dorsal venous complex, endopelvic fascia, and other structures involved in the support of the urethrovesical segment, and is associated with early recovery of urinary continence. Due to the specific surgical anatomy of this approach, standardization of the main operative steps and assessment of its reproducibility in clinical practice are required. Aim . To analyze experience with Retzius-sparing robot-assisted radical prostatectomy at the University Urology Clinic of the the Moscow Multidisciplinary Clinical Centre “Kommunarka”, Moscow Healthcare Department, and to demonstrate key steps of the surgical technique. Materials and methods . Between 2025 and the present, 30 Retzius-sparing robot-assisted radical prostatectomies have been performed at the University Urology Clinic using the da Vinci Xi robotic surgical system. Intraoperative parameters, early postoperative course, pathological findings, and continence recovery dynamics were analyzed. Results . Mean operative time was 187.71 ± 32.66 min, and median blood loss was 30 mL. Median durations of urethral catheter drainage and postoperative hospital stay were 6 days. Pathological examination revealed pT2 disease in 92.9 % of cases and pT3a disease in 7.1 %. Gleason scores of 3 + 3 and 3 + 4 were identified with equal frequency, each accounting for 50.0 % of cases. The positive surgical margin rate was 28.6 %. Complete recovery of urinary continence was observed in 86 % of patients at 1 month and in 98 % at 3 months. The article also presents a step-by-step description of the surgical technique, including trocar placement, posterior access to the prostate, mobilization of the seminal vesicles, bladder neck dissection, urethral mobilization, and urethrovesical anastomosis formation. Conclusion . The initial experience with Retzius-sparing robot-assisted radical prostatectomy at the University Urology Clinic confirms its technical feasibility and efficacy (achieving favorable early functional outcomes). At the same time, the positive surgical margin rate indicates the need for careful patient selection, standardization of key operative steps, and further assessment of the oncological safety of this approach in larger case series.

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