Open Anterograde Anatomic Radical Prostatectomy, a technique developed at Rio de Janeiro State University.

Introduction: Radical prostatectomy is the gold standard treatment for localized prostate cancer, and videolaparoscopic prostatectomy represents a new leap forward. However, the latter approach adds great technical complexity and entails a long and very slow learning curve that can be successfully completed by only a small number of highly skilled surgeons. These factors have significantly hampered a more widespread uptake of this technique. Robotic-assisted laparoscopic surgery democratized laparoscopic radical prostatectomy by allowing many surgeons, even the least experienced ones, to perform this procedure with the same expertise as experienced surgeons. Nevertheless, the high cost of this technology greatly limits its more widespread use, especially in countries in the global south. Methodology: In 2015, a discussion began on the possibility of using some concepts from laparoscopic prostatectomy to improve open prostatectomy. Based on a study of the various techniques performed using the open, laparoscopic and robotic route, we developed an innovative technique to reproduce robotic prostatectomy openly, without recourse to any new special instruments or materials. This technique is called "Open Anterograde Anatomic Radical Retropubic Prostatectomy" (AORP). Results: AORP was superior to Open Radical Prostatectomy in critical parameters: a median estimated blood loss of 300mL versus 500mL (p=0.0003); more rapid urethrovesical anastomosis, at 20min versus 25min (p=0.005); shorter duration of indwelling vesical catheterization, at 7 versus 14 days; increased surgeon perception of nerve-sparing, at 101 (87.8%) versus 71 (67.6%) (p=0.0009); increased early urinary continence, at 70 (60.9%) versus 45 (42.0%); fewer complications (p=0.007) and equivalent oncological control. Discussion: We understand that the gains of robotic surgery depend not only on the introduction of technology but also on improvements in the technique of dissection, preservation and reconstruction that can be reproduced in open surgery, thus enabling similar operations with improved procedures but without access to robotic technology. [ABSTRACT FROM AUTHOR]