Retzius sparing prostatectomy: the operation in 10 steps (and its advantages and disadvantages)

The Retzius sparing prostatectomy (RRP), also called Robotic Retzius-sparing radical prostatectomy is a surgical technique used to cure prostate cancer. It is a minimally invasive operation, since it involves small incisions.

It is performed through the use of a surgical robot called the Da Vinci, which is a surgical tool made of multiple robotic hands which are remotely controlled by the surgeon.

What is the Retzius space

Retzius space, also known as the Retzius cavity (or prevesical space), is a potential space in the pelvic region located between the bladder and the pubic bone. Preserving the Retzius space during prostatectomy can have potential benefits, including reducing the risks of complications and improving postoperative outcomes.

The Retzius sparing prostatectomy in detail

The Retzius sparing prostatectomy represents a sort of evolution of the traditional prostatectomy. Let’s see what are these differences and how does a Retzius sparing prostatectomy actually work.

The Retzius sparing prostatectomy and the traditional one: the differences

The prostatectomy is a surgical procedure performed to remove the prostate gland, often due to prostate cancer.

With the traditional open or laparoscopic prostatectomy procedures, surgeons may need to navigate through or around the Retzius space, potentially causing damages to the surrounding structures. In recent years, surgical techniques have evolved to minimize trauma to adjacent tissues and improve postoperative outcomes.

The RRP technique reduces urinary incontinence and erectile dysfunction, both common side effects of traditional prostatectomy procedures.

The RRP: preparing the patient

Before the operation, the patient needs to be counseled to get his informed consent. The doctor then proceeds with a series of tests to ensure that the patient can effectively undergo the operation without damages.

In other words, the doctor checks if the patient is in good health for the surgery. The tests include blood work, urine analysis, PSA tests and other.

The patients must avoid eating anything for 8 hours before the operation.

The Retzius spare prostatectomy procedure

In order to perform a Retzius spare prostatectomy, the surgeon makes several small incisions in the patient’s abdomen. The surgeon then inserts small surgical instruments in the body. These include a tool with a small camera attached to it, which allows the surgeon to monitor the operation on a screen.

The surgeon then uses robotic arms to remove the prostate gland while preserving the surrounding nerves, the blood vessels, and the muscles. The use of a robotic-assisted approach allows for a greater precision during surgery.

RRP: the steps

To summarize, let’s take a look at all the steps of an RRP procedure:

An IV line is passed into the patient’s arm to push the needed fluids.
The patient gets sedated and the vital organs are monitored by an anesthetist.
The surgeon operates the Da Vinci robot using controls.
Small incisions are made in the patient’s abdomen for robotic arms and camera to allow the surgeon to see the internal view.
Once inside, the robot arms are controlled by the surgeon in order to move various structures and organs out the way until the prostate gland is reached.
The prostate tissue gets dissected in sequence and the tissue removed.
The Retzius cave gets spared.
A Supra public catheter is placed temporarily inside the patient’s body for about 1 week as part of the healing process.
The robot extension and camera are removed and the initial incisions are sutured.
The patient is brought out of anesthesia and placed in post-operative care.

The post-op, the recovery and the care plan

After the operation, the patient is kept in the recovery room for observation, with their vital organs monitored. NSAIDs and paracetamol are given for pain management.

The patient is then shifted to a separate room in a few hours, and they can begin to drink liquids by evening. The patients then get discharged when they’re able to move about (usually after just 1 day). The wounds must be kept clean.

Usually, the patients are expected to return to their normal lives within 6 weeks from the operation.

Potential advantages of the Retzius sparing prostatectomy

There are several advantages related to the Retzius sparing prostatectomy. These include:

Shorter operation time compared to a traditional prostatectomy. The Retzius sparing prostatectomy is definitely quicker.
Lower risk of urinary incontinence. The RRP can result in less damage to the muscles and nerves, which control the bladder’s functions, resulting in lower risk of post-surgery urinary continence.
Faster recovery of continence. Patients who undergo the Retzius sparing technique may regain urinary continence very quickly.
Reduced blood loss: with the Retzius sparing prostatectomy the patients lose little amounts of blood.
Improved sexual function. By minimizing nerve damage during the surgery, erectile functions are preserved.

Potential disadvantages of the Retzius sparing prostatectomy

On the other hand, there are also some disadvantages to the use of the RRP. Let’s take a look at them:

The operation is particularly difficult, thus requiring specialized surgical skills.
RPP isn’t suitable for all patients, especially for those with a prostate that is too large or that have a cancer in a more advanced stage.
Nerve damage potential: the operation still has a risk of nerve damage that can lead to erectile dysfunction or other sexual problems, despite the fact that the Retzius sparing prostatectomy aims to preserve the neurovascular bundle.
And last, the operation has limited long-term data. In fact, although the operation’s results have been positive so far, there’s still limited evidence regarding its safety and efficiency.

Patients should always discuss the potential risks of the Retzius sparing prostatectomy with their doctor before accepting to undergo the operation.

Who can undergo a Retzius sparing prostatectomy

As we said, a Retzium sparing prostatectomy is not well suited for all kinds of patients, and there are specific types of people who straight up can’t undergo this type of operation.

Usually the patients with focal, well differentiated tumors are the most suitable for an RRP operation. People with high volume, poorly differentiated tumors may instead be at a higher risk.

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