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Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts’ consensus

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Abstract

Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts’ panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.

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Authors and Affiliations

  1. Hospital Felicio Rocho, Belo Horizonte, MG, Brazil

    Eliney Ferreira Faria & Carlos Vaz Melo Maciel

  2. Hospital Moinhos de Vento, Porto Alegre , RS, Brazil

    André Berger & Gustavo Franco Carvalhal

  3. University of São Paulo, São Paulo, SP, Brazil

    Anuar Mitre & Marcos Dall’Oglio

  4. Hospital Aristides Maltez, Salvador, BA, Brazil

    Breno Dauster

  5. Hospital Benefiencia Portuguesa, São Paulo, SP, Brazil

    Celso Heitor Freitas Jr

  6. Hospital Real Portugues, Recife, PE, Brazil

    Clovis Fraga

  7. Instituto Cancer de São Paulo, São Paulo, SP, Brazil

    Daher Chade & Rafael Coelho

  8. Hospital Porto Dias, Belem, PA, Brazil

    Francisco Carvalho

  9. Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil

    Franz Campos

  10. Hospital Albert Einstein, São Paulo, SP, Brazil

    Gustavo Caserta Lemos & Murilo Luz

  11. Hospital Benefiencia Portuguesa, São Paulo, SP, Brazil

    Gustavo Guimarães

  12. Instituto do Cancer, São Paulo, SP, Brazil

    Hamilton Zampolli

  13. Hospital de Base de Brasilia, Brasilia, DF, Brazil

    Joao Ricardo Alves

  14. Hospital Moriah, São Paulo, SP, Brazil

    Joao Pádua Manzano

  15. Instituto Dor, Rio de Janeiro, RJ, Brazil

    Marco Antônio Fortes

  16. Hospital Monte Klinikun, Fortaleza, CE, Brazil

    Marcos Flavio Holanda Rocha

  17. University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Mauricio Rubinstein

  18. Hospital Felício Rocho, Belo Horizonte, MG, Brazil

    Pedro Romanelli

  19. Hospital Americas, Rio de Janeiro, RJ, Brazil

    Raphael Rocha

  20. Hospital de Cancer de Barretos, Barretos, SP, Brazil

    Roberto Dias Machado

  21. University of São Paulo, Ribeirão Preto, SP, Brazil

    Rodolfo Borges dos Reis & Valdair Muglia

  22. AC Camargo, São Paulo, SP, Brazil

    Stenio Zequi

  23. Hospital Quinta Dor, Rio de Janeiro, RJ, Brazil

    Romulo Guida

  24. Faculdade de Medcina ABC, São Paulo, SP, Brazil

    Marcos Tobias-Machado

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  1. Eliney Ferreira Faria
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  2. Carlos Vaz Melo Maciel
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  3. André Berger
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Correspondence to Eliney Ferreira Faria.

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Conflict of interest

Eliney Ferreira Faria, Carlos Vaz Melo Maciel, André Berger, Anuar Mitre, Breno Dauster, Celso Heitor Freitas Jr, Clovis Fraga, Daher Chade, Marcos Dall’Oglio, Francisco Carvalho, Franz Campos, Gustavo Franco Carvalhal, Gustavo Caserta Lemos, Gustavo Guimarães, Hamilton Zampolli, Joao Ricardo Alves, Joao Pádua Manzano, Marco Antônio Fortes, Marcos Flavio Holanda Rocha, Mauricio Rubinstein, Murilo Luz, Pedro Romanelli, Rafael Coelho, Raphael Rocha, Roberto Dias Machado, Rodolfo Borges dos Reis, Stenio Zequi, Romulo Guida, Valdair Muglia, Marcos Tobias-Machado, declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained by email from all panelists before to receive the questionnaire. The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Faria, E.F., Maciel, C.V.M., Berger, A. et al. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts’ consensus. J Robotic Surg 15, 829–839 (2021). https://doi.org/10.1007/s11701-020-01186-0

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