Retzius sparing robotic radical prostatectomy: Technical variations and results of Latin America multicentric collaboration

Objective To describe the technical adaptations applied during Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) by experienced Latin American surgeons, and to report perioperative and early functional outcomes from a large multicentre collaborative cohort. Patients and Surgical Procedure This retrospective multicentre observational study included 1274 consecutive patients who underwent RS-RARP between 2018 and 2023 at eight centres in Brazil, Mexico and Argentina. All procedures followed the fundamental principles of the Retzius-sparing (Bocciardi) approach, reaching the prostate through the pouch of Douglas without dissection of the anterior compartment. Technical adaptations were defined a priori as modifications of an individual operative step performed within this standardized framework, and were documented at seven predefined operative steps, from sigmoid colon traction to posterior reconstruction. Continence was assessed by daily pad use and erectile function by the Sexual Health Inventory for Men (SHIM), potency being defined as a score of 17 or higher. Results Median age was 62 years and median body mass index 27.1 kg/m²; mean prostate volume was 45.1 cc. D'Amico risk was low in 260 patients (20.4%), intermediate in 594 (46.6%) and high in 420 (33.0%). Median console time was 115 minutes and mean estimated blood loss 226.8 mL. Pad-free continence was 87.1%, 93.1% and 96.1% at 1, 3 and 6 months, and 96.7% at 12 months. Potency was recovered by 45.1% of patients at 12 months. Conclusion Seven reproducible categories of technical adaptation were identified within a standardized RS-RARP framework, associated with favourable perioperative safety and rapid recovery of urinary continence.