Latero-Posterior Approach–Gaston modified technique, Las Palmas Approach–Gaston modified technique (LPA-G) for robot-assisted radical prostatectomy

Abstract

Objectives: To evaluate perioperative, pathological, and functional outcomes of radical prostatectomy using the Latero-Posterior Approach-Gaston modified technique, Las Palmas Approach-Gaston modified technique (LPA-G) 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 the standardized LPA-G between 2023–2026. The technique incorporated a posterior approach to the seminal vesicles and then intrafascial, tension and energy-minimizing dissection of the neurovascular bundles with preservation of the bladder neck and the 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 27/138 patients (19.6%). 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. Median total operative time did not decrease across chronological periods (137, 161, and 205 minutes; P = 0.129).
Conclusions: Robot-assisted radical prostatectomy using the LPA-G 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, Latero-Posterior Approach-Gaston modified technique, Las Palmas Approach-Gaston modified technique (LPA-G), pubovesical complex, urinary continence, erectile function