Finger Dissection Open Radical Prostatectomy Offers Equal Early Functional Results with Robotic Prostatectomy in the Robotic Era: A Comparative Study

doi:10.21203/rs.3.rs-4953848/v1

BACKGROUND: Apical dissection is a crucial step of radical prostatectomy (RP) for postoperative functional outcomes. Robot-assisted laparoscopic RP (RALRP) represents a good visualization for this stage and bleeding during ligation of dorsal vein complex (DVC) is a challenging problem in open RP (ORP). In our study, the results of finger dissection technique in open RP were evaluated and compared with RALRP.

METHODS: We retrospectively reviewed 184 patients who underwent RP for clinically localized prostate cancer. Blunt finger dissection technique performed for ligation of DVC in ORP and patients were divided into two groups according to the surgical method (Group 1:RALRP; Group 2:FD-ORP – Finger dissection-ORP). The primary outcomes were continence status and erectile functions. Demographics, operative outcomes, preoperative and postoperative oncological data were also recorded.

RESULTS: Ninety-two patients in each group were enrolled in the study. Demographics and preoperative data were similar. Also, there is no difference between groups in terms of operation time, blood loss, transfusion rates, hospitalization time, and peri- and postoperative complications (p>0.05). Urethral catheterization time was higher in FD-ORP (median day 14 vs. 21, p<0.001). Continence rates (82.6% vs. 89.1%, p=0.439) and erectile functions (mean IIEF: 10.62 vs. 11.34, p=0.107) showed no significant difference between FD-ORP and RALRP in the first year after surgery.

CONCLUSION: Finger dissection of the DVC during ORP is a simple and feasible technique that provides the correct plane on the urethra, resulting in better apical dissection with effective hemostasis. Although it shows similar early functional results as RALRP, more research is needed.

dorsal vein complex

open radical prostatectomy

prostate cancer

robot-assisted radical prostatectomy

Radical prostatectomy (RP) is considered the gold standard in the treatment of localized prostate cancer ¹. RP can be performed by open, laparoscopic or robot-assisted methods. Robot-assisted laparoscopic RP (RALRP) has been increasing in accessibility and applicability worldwide since it was first described in 2000 ². Otherwise, the higher cost stands as an essential disadvantage of RALRP ³ and open RP (ORP) is still frequently preferred in most centres. Although postoperative oncological and functional outcomes are similar in both open and robot-assisted methods, perioperative bleeding is higher in ORP ^4,5. Increased bleeding is a challenging problem for visualization, especially during apical dissection. In this regard, ligation of the dorsal vein complex (DVC) is one of the critical steps with the highest risk of bleeding.

In the ORP, the suturation of the DVC is frequently preferred to control bleeding. Alternatively, the finger dissection technique has been defined as targeting less bleeding in the ligation of the DVC ⁶. With the reduction of bleeding, visualization may be more precise and eventually facilitate better apical dissection. Although there are many studies comparing ORP and RALRP, data on finger dissection technique in open radical prostatectomy (FD-ORP) are limited.

In this present study, we aimed to evaluate peri- and postoperative outcomes of two methods which are FD-ORP and RALRP.

Study population

One hundred eighty-four patients who underwent RP from 2017 to 2021 were retrospectively evaluated after approval from the local ethics committee (approval number: E-71522473-050.01.04-39876-351). Patients were divided into two groups according to the surgical method (Group 1: RALRP; Group 2: FD-ORP). Age, prostate volume, prostate specific antigen (PSA), operation time, estimated blood loss, postoperative transfusion status, hospitalization and urethral catheterization time were recorded. Preoperative (positive core number, Gleason score, clinical stage) and postoperative pathological data (Gleason score, pathological stage, capsular invasion, positive surgical margin, extraprostatic extension, seminal vesicle invasion, lymphovascular invasion, perineural invasion) were analyzed. Patients’ lower urinary tract symptoms were evaluated by the international prostate symptom score (IPSS) form. Charlson comorbidity index (CCI) was calculated to analyze preoperative comorbidity status. Peri- and postoperative complications were evaluated according to the Clavien-Dindo classification. Postoperative continence status at 1, 3, 6 and 12th months were evaluated by daily ped count and classified as a continent (0-safety ped), mild (1-2 ped) and severe (>2 peds) incontinent. The international index of erectile function (IIEF) short form was used to evaluate erectile functions of patients before surgery and at 1, 3, 6 and 12th months postoperatively.

Surgical technique for finger dissection

Under general anaesthesia, the patient was placed supine position with the light Trendelenburg, and a midline vertical incision was performed below the umbilicus. After separating the fatty tissues, the bilateral endopelvic fascia was opened, and the levator muscle was separated from the prostate with a small sponge stick. Puboprostatic ligaments were cut with a harmonic scalpel or ligasure®. The urethra with a catheter was palpated and felt by the inner surface of the index finger at the prostatic apex. Blunt finger dissection was performed gently between the DVC and the urethra, from both sides with the index finger and thumb; so, the urethra and DVC were separated from each other, and approximately 2 cm gap was created (Figure 1). The DVC was ligated two times with one vicryl by passing a right-angle clamp through the created space and cut sharply by avoiding cutting the sutures. Back bleeding sutures were put in the middle part of the prostate if necessary. After cutting the urethra, radical prostatectomy was completed in the standard procedure. Uni- or bilateral nerve-sparing surgery was performed in low- and intermediate-risk patients but not high-risk patients.

Statistical analysis

Statistical analyses were performed using IBM SPSS Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA). The Kolmogorov-Smirnov test was used to evaluate the appropriateness of the data to a normal distribution. Continuous variables with normal distribution were shown by the mean and standard deviation (SD), whereas variables with non-normal distribution were shown by median and minimum-maximum (min-max). The categorical variables were shown as the number of cases (n) and percentage (%). An independent sample t-test or Mann-Whitney U test was used to compare continuous data, and categorical data were analyzed with the chi-square test. P values< 0.05 were considered significant.

Data availability

The data associated with the paper are not publicly available but are available from the corresponding author on reasonable request.

A total of 184 patients, 92 in each group, were enrolled in the study. Age, prostate volume, PSA, IPSS, and CCI were similar in both groups (p>0.05). In preoperative pathological data, there was no significant difference between groups in terms of positive core number, Gleason score and clinical stage (p>0.05) (Table 1).

According to the analysis of perioperative and postoperative data, operation time, estimated blood loss, nerve-sparing status, postoperative transfusion status, hospitalization time, and peri- and postoperative complications were similar in both groups (p>0.05). Urethral catheterization time was higher in FD-ORP (p<0.001). Except for the lymphovascular invasion rate, which was higher in FD-ORP (8.7% vs 19.6%; p=0.034), there was no significant difference in postoperative pathological data between the groups (p>0.05) (Table 2). Incontinence rates were given in Table 3, and no significant difference was found between groups at postoperative 1, 3, 6 and 12th months (p=0.529, 0.263, 0.532, 0.439, respectively). Erectile functions were evaluated before surgery, and at postoperative 1, 3, 6 and 12th months and between RALRP and FD-ORP, IIEF scores showed no significant difference at all months (p=0.859, 0.100, 0.146, 0.143 and 0.107 respectively) (Figure 2).

The main goals for RP are; the removal of the prostate tissue with a negative surgical margin, ensuring postoperative continence and preserving erectile functions ⁷. In this context, apical dissection is an essential step in RP. Bleeding, one of the most considerable problems during surgery, mainly cause inadequate exposure. To achieve these aims, a bloodless surgical area is necessary. DVC is the primary source of bleeding during RP, and the successful control of DVC enables less bleeding and more accurate apical dissection ⁸. In this present study, finger dissection in ORP was performed as an alternative method for ligation of DVC. No difference was found in terms of perioperative, postoperative pathological and functional outcomes compared with RALRP.

Intraoperative bleeding is one of the factors which can pose challenges in surgery. Increased blood loss during RRP is associated with poorer outcomes. Lloyd et al. reported a significant correlation between estimated blood loss and PSA recurrence ⁹. Preisser et al. investigated the effect of blood loss during RP on functional outcomes. They stated that high blood loss during ORP or RALRP represents an independent predictor of erectile dysfunction and incontinence after surgery ¹⁰. As a result of a better understanding of DVC anatomy, less intraoperative blood loss has been reported over the years ¹¹. However, previous studies have shown that ORP is associated with higher blood loss compared to RALRP and higher postoperative transfusion rates as well ^12,13. Blunt finger dissection of DVC in RP was aimed at lowering blood loss. Namiki et al. reported that median blood loss was 675 mL in their cohort of 54 men ⁶. Cristini et al. used the same technique and successfully performed it on 53 men, and mean blood loss was reported as 620 mL ¹⁴. Both reports are cohort analyses without comparison with any group. In our study, the median estimated blood loss was 177 mL (50-380 mL), the postoperative transfusion rate was 6.5% in FD-ORP, and there was no significant difference with RALRP (p= 0.121, 0.295, respectively). This report, in terms of blood loss, showed comparable results to RALRP with this technique in ORP.

With the increase in surgical experience, the operation time of both ORP and RALRP has shortened. Although many studies in the past years have shown that RALRP has a longer operation time ^15,16, in a recently reported randomized controlled study, shorter operation time has been indicated for RALRP compared to ORP ⁴. Our study found similar operation times for FD-ORP and RALRP (p=0.140). The fact that the operation time was no longer in the FD-ORP group compared to RALRP may suggest that finger dissection of DVC may improve the operation time.

There is a belief that the hospitalization time is shorter in RALRP due to its minimally invasive surgical nature compared to ORP. In a large systematic review, ORP was associated with longer hospital stays ³. Conversely, Haese et al. stated no significant difference in length of hospital stay between RALRP and ORP in their comparative study with 10,790 men ¹⁷. Moreover, another study reported a shorter postoperative length of hospital stay for ORP ¹⁸. We found similar hospitalization times in our study (p=0.625). This may result from the reduction in blood loss provided by the finger dissection technique. Djavan et al. have investigated the impact of blood loss during RP on clinical outcomes. They have shown that a lower reduction in haematocrit is associated with a shorter length of hospital stay ¹⁹.

Removal of the urethral catheter after RP varies in the literature for any procedure. In general, urethral catheterization time has been reported to be longer in ORP ^3,17,18, and our results are consistent with the literature. For urethrovesical anastomosis, a running suture is placed with Van Velthoven's single knot technique in RALRP, while 4 to 6 separated sutures are placed in ORP. Therefore, surgeons may feel more confident about the tightness of the urethrovesical anastomosis in RALRP and may consider a shorter time sufficient to remove the urethral catheter.

Most studies have shown that postoperative complications were similar between RALRP and ORP ^16,20. However, Ryu et al. stated that major complications were less common in RALRP than in ORP ²¹. In our cohort, there was no statistical difference between the groups in terms of Clavien 3 and above complication rates. FD-ORP was as safe as RALRP in terms of both preoperative and postoperative complications.

According to our pathological results, no significant difference was observed between groups except for lymphovascular invasion rates. Surgical margin status is an important prognostic factor in predicting biochemical recurrence ^22,23. In our results, consistent with a randomized controlled trial ⁴, positive surgical margin rates did not differ significantly between the two groups. In addition, a systematic review and meta-analysis and a nationwide cohort study have supported these findings, and PSM rates are similar between RALRP, ORP and LRP ^24,25. Cristini et al. reported a positive surgical margin rate of 14% in their study in which digital dissection was used to control DVC in ORP ¹⁴. This rate was lower but close to our finding (18.5% in the FD-ORP group).

A prospective randomized controlled study has shown no difference in urinary incontinence and erectile dysfunction at six and 12th weeks between ORP and RALRP ⁴. Subsequently, Coughlin et al. reported mid-term results for 6, 12 and 24th months and showed that ORP or RALRP were not superior to each other in terms of functional outcomes ⁵. In our study, there was also no difference in urinary incontinence and erectile functions at 12 months follow-up. Another study with long-term follow-up comparing RALRP and ORP has also confirmed these results ²⁶. Although not comparative, the functional outcomes of studies using finger dissection to control DVC are promising. In the first study by Namiki et al., total urinary control was reported as 93%. Also, in this report, 52% of the patients who were potent before surgery rated their sexual function as good or very good at 12 months postoperatively, 75% of whom were under PDE-5 therapy ⁶. In another study, Cristini et al. reported continence and potency rates as 88% and 41%, respectively, at a minimum one-year follow-up ¹⁴. More recently, Atan et al. used this technique to ligate DVC, and the continence rate was 92.4% in the 3rd month ²⁷. Although there was no difference between the groups, we had lower continence rates (89.1% in RALRP vs 82.6% in FD-ORP at postoperative 12^th month). This difference may be since we have chosen a strict definition for continence. To evaluate erectile functions, we used the IIEF-5 scoring system. In the twelfth month, IIEF-5 scores were 11.34 in RALRP and 10.62 in FD-ORP, and there was no difference between groups. These rates are lower than the results of the studies mentioned above. However, the erectile functions of our patients were not good enough in the beginning either (IIEF-5 scores: 18.02 in RALRP and 18.12 in FD-ORP preoperatively).

Additionally, intraoperative blood loss may have an impact on postoperative functional outcomes. Djavan et al. emphasized that blood loss does not adversely affect postoperative functional results in ORP. Moreover, they concluded that the lower blood loss associated with RALRP compared to ORP is not expected to improve functional outcomes ¹⁹. Conversely, in a more recent and larger study, higher blood loss was found to be associated with worse functional outcomes. In particular, the effect of blood loss on continence was related to short-term results ¹⁰. We believe that the significant impact of blood loss on functional outcomes is related to better visualization of the operative field. Thus, optimal apical dissection is provided. A sufficiently long urethra and a shorter length of the resected membranous urethra are associated with better postoperative continence recovery ²⁸. Furthermore, more electrocautery use due to higher blood loss may increase the likelihood of developing incontinence by causing damage to the rhabdosphincter and the likelihood of developing erectile dysfunction by causing periprostatic nerve damage.

Our study has some limitations. Firstly, because of its retrospective design, no randomized comparison was made, and it relies on a single-institution database. Secondly, prostatectomies were performed by more than one surgeon. Thirdly, long-term oncological and functional outcomes were unavailable due to the short follow-up period. Finally, the low number of patients was another limitation. Despite these limitations, to the best of our knowledge, this is the first study to compare the finger dissection technique in ORP with RALRP.

In conclusion, the finger dissection technique in ORP represents a favourable improvement in blood loss which is almost as lower as RALRP. This technique obtained comparable postoperative pathological and short-term functional outcomes between RALRP and ORP. In this regard, applying this technique in ORP may facilitate surgery, and apical dissection and, therefore, may improve postoperative outcomes by reducing blood loss which is higher than RALRP. More studies are needed to understand the benefits of this technique better.

CCI: Charlson comorbidity index

DVC: Dorsal vein comples

FD: Finger dissection

IPSS: International prostate symptom score

ORP: Open radical prostatectomy

PSA: Prostate specific antigen

RALRP: Robot-assisted laparoscopic radical prostatectomy

RP: Radical prostatectomy

Acknowledgement: None

Statement of all funding sources of support for this work: None

Author Contribution statement:

Conceptualization: Yavuz Tarik Atik, Haci Ibrahim Cimen, Hasan Salih Saglam. Data curation: Burak Uysal. Formal Analysis: Deniz Gul, Anil Erdik. Methodology: Haci Ibrahim Cimen, Hasan Salih Saglam. Project administration: Yavuz Tatik Atik, Haci Ibrahim Cimen. Supervision: Osman Kose, Hasan Salih Saglam. Visualization: Burak Uysal. Writing – original draft: Yavuz Tarik Atik, Deniz Gul. Writing – review & editing: Haci Ibrahim Cimen, Osman Kose, Hasan Salih Saglam, Anil Erdik, Burak Uysal. All authors discussed the results and contributed to the final manuscript.

Ethics statement

The present study protocol was reviewed and approved by the institutional review board of Sakarya University Faculty of Medicine (Reg. No: E-71522473-050.01.04-39876-351). Informed consent was submitted by all subjects when they were enrolled.

Funding

The study did not receive any funding.

Conflict of interest

The authors declare no conflicts of interest statement.

Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000;163(6):1802-1807.
Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408-410. doi:10.1046/j.1464-410x.2001.00115.x
Basiri A, de la Rosette JJ, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol. 2018;36(4):609-621. doi:10.1007/s00345-018-2174-1
Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet (London, England). 2016;388(10049):1057-1066. doi:10.1016/S0140-6736(16)30592-X
Coughlin GD, Yaxley JW, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol. 2018;19(8):1051-1060. doi:10.1016/S1470-2045(18)30357-7
Namiki K, Kasraeian A, Yacoub S, Rosser CJ. Blunt apical dissection during anatomic radical retropubic prostatectomy. BMC Res Notes. 2009;2:20. doi:10.1186/1756-0500-2-20
Eastham JA, Scardino PT, Kattan MW. Predicting an optimal outcome after radical prostatectomy: the trifecta nomogram. J Urol. 2008;179(6):2201-2207. doi:10.1016/j.juro.2008.01.106
Tüfek I, Atuğ F, Argun B, et al. The use of a bulldog clamp to control the dorsal vein complex during robot-assisted radical prostatectomy. J Endourol. 2012;26(12):1605-1608. doi:10.1089/end.2012.0153
Lloyd JC, Bañez LL, Aronson WJ, et al. Estimated blood loss as a predictor of PSA recurrence after radical prostatectomy: results from the SEARCH database. BJU Int. 2010;105(3):347-351. doi:10.1111/j.1464-410X.2009.08792.x
Preisser F, Pompe RS, Salomon G, et al. Impact of the estimated blood loss during radical prostatectomy on functional outcomes. Urol Oncol. 2019;37(5):298.e11-298.e17. doi:10.1016/j.urolonc.2019.01.006
Stav K, Rahimi-Levene N, Lindner A, Siegel YI, Zisman A. Retropubic radical prostatectomy: associated blood loss and transfusion requirements--a two-decade perspective review. Isr Med Assoc J. 2005;7(2):103-106.
Dell’Oglio P, Mottrie A, Mazzone E. Robot-assisted radical prostatectomy vs. open radical prostatectomy: Latest evidences on perioperative, functional and oncological outcomes. Curr Opin Urol. 2020;30(1):73-78. doi:10.1097/MOU.0000000000000688
Farnham SB, Webster TM, Herrell SD, Smith JAJ. Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology. 2006;67(2):360-363. doi:10.1016/j.urology.2005.08.029
Cristini C, Di Pierro GB, Leonardo C, De Nunzio C, Franco G. Safe digital isolation of the santorini plexus during radical retropubic prostatectomy. BMC Urol. 2013;13:13. doi:10.1186/1471-2490-13-13
Guazzoni G, Cestari A, Naspro R, et al. Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomised, single-surgeon study. Eur Urol. 2006;50(1):98-104. doi:10.1016/j.eururo.2006.02.051
Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002;60(5):864-868. doi:10.1016/s0090-4295(02)01881-2
Haese A, Knipper S, Isbarn H, et al. A comparative study of robot-assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures. BJU Int. 2019;123(6):1031-1040. doi:10.1111/bju.14760
Pompe RS, Beyer B, Haese A, et al. Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy using standardised reporting systems. BJU Int. 2018;122(5):801-807. doi:10.1111/bju.14369
Djavan B, Agalliu I, Laze J, Sadri H, Kazzazi A, Lepor H. Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates. BJU Int. 2012;110(1):69-75. doi:10.1111/j.1464-410X.2011.10812.x
Doumerc N, Yuen C, Savdie R, et al. Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int. 2010;106(3):378-384. doi:10.1111/j.1464-410X.2009.09158.x
Ryu J, Kwon T, Kyung YS, et al. Retropubic versus robot-assisted laparoscopic prostatectomy for prostate cancer: a comparative study of postoperative complications. Korean J Urol. 2013;54(11):756-761. doi:10.4111/kju.2013.54.11.756
Meeks JJ, Eastham JA. Radical prostatectomy: positive surgical margins matter. Urol Oncol. 2013;31(7):974-979. doi:10.1016/j.urolonc.2011.12.011
Yossepowitch O, Briganti A, Eastham JA, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. 2014;65(2):303-313. doi:10.1016/j.eururo.2013.07.039
Novara G, Ficarra V, Mocellin S, et al. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):382-404. doi:10.1016/j.eururo.2012.05.047
Chang S-C, Chen H-M, Wu S-Y. There Are No Differences in Positive Surgical Margin Rates or Biochemical Failure-Free Survival among Patients Receiving Open, Laparoscopic, or Robotic Radical Prostatectomy: A Nationwide Cohort Study from the National Cancer Database. Cancers (Basel). 2020;13(1). doi:10.3390/cancers13010106
Lantz A, Bock D, Akre O, et al. Functional and Oncological Outcomes After Open Versus Robot-assisted Laparoscopic Radical Prostatectomy for Localised Prostate Cancer: 8-Year Follow-up. Eur Urol. 2021;80(5):650-660. doi:10.1016/j.eururo.2021.07.025
Atan A, Tuncel A, Polat F, Balcı M, Yeşil S, Köseoğlu E. Seperation of dorsal vein complex from the urethra by blunt finger dissection during radical retropubic prostatectomy. Turkish J Urol. 2015;41(2):108-111. doi:10.5152/TUD.2015.67699
Kohjimoto Y, Yamashita S, Kikkawa K, Iba A, Matsumura N, Hara I. The Association of Length of the Resected Membranous Urethra With Urinary Incontinence After Radical Prostatectomy. Urol J. 2020;17(2):146-151. doi:10.22037/uj.v0i0.4753

Table 1 Comparison of preoperative data

		RALRP (n=92)	FD-ORP) (n=92)	p
Age (yr) (mean±SD)		63.88±6.19	63.89±5.55	0.990^a
Prostate volume (cc) (min-max)		55 (22-120)	50 (30-126)	0.700^b
PSA (ng/dl) (min-max)		7.60 (1.21-39)	8.70 (1.20-100)	0.106^b
IPSS (min-max)		12 (1-29)	11 (4-32)	0.328^b
CCI (min-max)		2 (1-5)	2 (1-5)	0.604^b
Positive core number (n) (min-max)		4 (1-12)	6 (1-11)	0.112^b
Preoperative gleason score (n) (%)	6	57 (62)	54 (58.7)	0.931^c
	7	31 (32.5)	34 (37)
	8	4 (4.3)	4 (4.3)
Clinical stage (n) (%)	T1b-c	19 (20.7)	19 (20.7)	0.651^c
	T2a-b	55 (59.8)	51 (55.4)
	T2c	18 (19.6)	22 (23.9)

Continous variables are shown as mean±SD or median (min-max), categorical variables are shown as number (percentage).

^a:Independent sample t test; ^b:Mann-Whitney U test; ^c:Chi-square test.

CCI:Charlson Comorbidity Index; FD-ORP:Finger dissection technique in open radical prostatectomy; IPSS:Internationa prostate symptom score; PSA:Prostate specific antigen; RALRP:Robot assisted laparoscopic radical prostatectomy; SD:Standart deviation

Table 2 Comparison of perioperative data and postoperative pathological parameters

			RALRP (n=92)	FD-ORP) (n=92)	p
Operation time (min-max)			200 (150-340)	200 (160-270)	0.140^a
Estimated blood loss (min-max)			140 (20-320)	177 (50-380)	0.121^a
Nerve sparing status (n) (%)	None		23 (25%)	27 (29.3%)	0.796^b
	Unilateral		8 (8.7%)	8 (8.7%)
	Bilateral		61 (66.3%)	57 (62%)
Perioperative complications, Clavien-Dindo score≥3, (n) (%)			3 (3.3%)	5 (5.4%)	0.720^b
Postoperative transfusion, yes (n) (%)			10 (10.9)	6 (6.5)	0.295^b
Hospitalization time (day) (min-max)			4 (3-14)	4 (3-6)	0.625^a
Urethral catheterization time (day) (min-max)			14 (10-21)	21 (14-21)	0,000^a
Postoperative complications, (0-30 days), Clavien-Dindo score≥3, (n) (%)			4 (4.3%)	6 (6.5%)	0.515^b
Postoperative complications, (0-90 days), Clavien-Dindo score≥3, (n) (%)			7 (7.6%)	10 (10.9%)	0.445^b
Postoperative gleason score (n) (%)		6	37 (40.2)	34 (37)	0,721^b
		7	40 (43.5)	44 (47.8)
		8	11 (12)	8 (8.7)
		9	4 (4.3)	6 (6.5)
Pathological stage (n) (%)		pT2a-b	17 (18.5)	18 (19.6)	0.950^b
		pT2c	42 (45.7)	43 (46.7)
		pT3a-b	33 (35.9)	31 (33.7)
Capsular invasion, yes (n) (%)			28 (30.4)	39 (42.4)	0.092^b
Positive surgical margin, yes (n) (%)			25 (27.2)	17 (18.5)	0.160^b
Extraprostatic extension, yes (n) (%)			30 (32.6)	33 (35.9)	0.641^b
Seminal vesicle invasion, yes (n) (%)			14 (15.2)	18 (19.6)	0.437^b
Lymphovascular invasion, yes (n) (%)			8 (8.7)	18 (19.6)	0.034^b
Perineural invasion, yes (n) (%)			65 (70.7)	56 (60.9)	0.162^b

^a:Mann-Whitney U test; ^b:Chi-square test.

Continous variables are shown as median (min-max), categorical variables are shown as number (percentage).

FD-ORP:Finger dissection technique in open radical prostatectomy; RALRP:Robot assisted laparoscopic radical prostatectomy

Table 3 Analysis of postoperative continence status

	RALRP	FD-ORP	p
1. Month	(n=92)	(n=92)		0.529
Continent (n) (%)	42 (45.6)	47 (51.1)
Mild incontinent (n) (%)	31 (33.7)	24 (26.1)
Severe incontinent (n) (%)	19 (20.7)	21 (22.8)
3. Month	(n=92)	(n=92)		0.263
Continent (n) (%)	63 (68.5)	65 (70.7)
Mild incontinent (n) (%)	22 (23.9)	15 (16.3)
Severe incontinent (n) (%)	7 (7.6)	12 (13.0)
6. Month	(n=92)	(n=92)		0.532
Continent (n) (%)	78 (84.8)	75 (81.5)
Mild incontinent (n) (%)	9 (9.8)	8 (8.7)
Severe incontinent (n) (%)	5 (5.4)	9 (9.8)
12. Month	(n=92)	(n=92)	0.439
Continent (n) (%)	82 (89.1)	76 (82.6)
Mild incontinent (n) (%)	6 (6.5)	9 (9.8)
Severe incontinent (n) (%)	4 (4.3)	7 (7.6)

Chi-square test was used for statistical analysis.

Data are shown as number (percentage).

FD-ORP:Finger dissection technique in open radical prostatectomy; RALRP:Robot assisted laparoscopic radical prostatectomy

No competing interests reported.

Finger Dissection Open Radical Prostatectomy Offers Equal Early Functional Results with Robotic Prostatectomy in the Robotic Era: A Comparative Study

Status:

Version 1

Abstract

Figures

Introduction

Materials and methods

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Tables

Additional Declarations

Status:

Version 1