The lateroposterior approach-Gaston for robot-assisted radical prostatectomy: the Las Palmas approach
Abstract
Objectives: To evaluate perioperative, pathological, and functional outcomes of radical prostatectomy using a lateroposterior approach with intrafascial neurovascular-bundle dissection and bladder neck preservation.
Methods: We conducted a retrospective, single-center study of patients who underwent robot-assisted radical prostatectomy using a standardized lateroposterior approach between 2023–2026. The technique incorporated a posterior approach to the seminal vesicles followed by intrafascial, tension-minimizing, and energy-minimizing dissection of the neurovascular bundles, with preservation of the bladder neck and pubovesical complex whenever oncologically appropriate. Preoperative, operative, pathological, complication, urinary-continence, and erectile-function data were collected. Functional outcomes were assessed at 1, 3, 6, 12, and 24 months.
Results: A total of 138 patients were included. Median age was 65 years (IQR 60–71), preoperative prostate-specific antigen was 6.79 ng/mL (IQR 5.02–10.6), and prostate volume was 43 mL (IQR 33–62). Median total operative, console, and docking times were 160 (IQR 120–236), 120 (IQR 81–195), and 16 minutes (IQR 13–21), respectively. Complications were documented in 25/127 patients (19.7%). Positive surgical margins occurred in 60/121 patients (49.6%), and higher preoperative PSA was independently associated with margin positivity (aOR 2.07, 95%CI 1.11–4.19). Continence increased from 54.5% at 1 month to 83.9% at 12 months. Erectile function increased from 39.7% at 1 month to 70.2% at 6 months. Operative time decreased over time, and complications numerically declined over time.
Conclusions: Robot-assisted lateroposterior radical prostatectomy was technically feasible and associated with progressive functional recovery among evaluable patients. The substantial positive-margin rate emphasizes the need for oncologically selective intrafascial dissection, standardized outcome assessment, and prospective comparative evaluation.
Keywords: Prostate cancer, robot-assisted radical prostatectomy, lateroposterior approach, pubovesical complex, urinary continence, erectile function