Name: Retzius-Sparing Robot-Assisted Radical Prostatectomy (Video) | JoVE Journal
Uploaded: 2022-05-19T14:00:00.000+00:00
Duration: 12 min 10 s
Description: Learn Retzius-sparing robot-assisted radical prostatectomy for prostate cancer treatment. This technique improves early urinary continence recovery while preserving anatomical structures during surgery.

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<ol><li>Mottet, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((EAU-EANM-ESTRO-ESUR-SIOG+Guidelines+on+Prostate+Cancer-2020+Update.+Part+1%3A+Screening%2C+Diagnosis%2C+and+Local+Treatment+with+Curative+Intent%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent.</a> European Urology. 79 (2), 243-262 (2021).</li>
<li>Ilic, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+and+robotic-assisted+versus+open+radical+prostatectomy+for+the+treatment+of+localised+prostate+cancer%5BTitle%5D)+AND+%22The+Cochrane+Database+of+Systematic+Reviews%22%5BJournal%5D)">Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer.</a> The Cochrane Database of Systematic Reviews. 9 (9), (2017).</li>
<li>Ab del Raheem, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Retzius-sparing+robot-assisted+radical+prostatectomy+versus+open+retropubic+radical+prostatectomy%3A+a+prospective+comparative+study+with+19-month+follow-up%5BTitle%5D)+AND+%22Minerva+Urologica+e+Nefrologica%3A+The+Italian+Journal+of+Urology+and+Nephrology%22%5BJournal%5D)">Retzius-sparing robot-assisted radical prostatectomy versus open retropubic radical prostatectomy: a prospective comparative study with 19-month follow-up.</a> Minerva Urologica e Nefrologica: The Italian Journal of Urology and Nephrology. 72 (5), 586-594 (2020).</li>
<li>Gandaglia, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparative+effectiveness+of+robot-assisted+and+open+radical+prostatectomy+in+the+postdissemination+era%5BTitle%5D)+AND+%22Journal+of+Clinical+Oncology+%3A+Official+Journal+of+the+American+Society+of+Clinical+Oncology%22%5BJournal%5D)">Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era.</a> Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 32 (14), 1419-1426 (2014).</li>
<li>Ficarra, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Systematic+review+and+meta-analysis+of+studies+reporting+urinary+continence+recovery+after+robot-assisted+radical+prostatectomy%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy.</a> European Urology. 62 (3), 405-417 (2012).</li>
<li>Martini, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Contemporary+techniques+of+prostate+dissection+for+robot-assisted+prostatectomy%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">Contemporary techniques of prostate dissection for robot-assisted prostatectomy.</a> European Urology. 78 (4), 583-591 (2020).</li>
<li>Galfano, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+new+anatomic+approach+for+robot-assisted+laparoscopic+prostatectomy%3A+a+feasibility+study+for+completely+intrafascial+surgery%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery.</a> European Urology. 58 (3), 457-461 (2010).</li>
<li>Checcucci, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Retzius-sparing+robot-assisted+radical+prostatectomy+vs+the+standard+approach%3A+a+systematic+review+and+analysis+of+comparative+outcomes%5BTitle%5D)+AND+%22BJU+International%22%5BJournal%5D)">Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes.</a> BJU International. 125 (1), 8-16 (2020).</li>
<li>Montorsi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Best+practices+in+robot-assisted+radical+prostatectomy%3A+recommendations+of+the+Pasadena+Consensus+Panel%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel.</a> European Urology. 62 (3), 368-381 (2012).</li>
<li>Stabile, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Multiparametric+MRI+for+prostate+cancer+diagnosis%3A+current+status+and+future+directions%5BTitle%5D)+AND+%22Nature+Reviews.+Urology%22%5BJournal%5D)">Multiparametric MRI for prostate cancer diagnosis: current status and future directions.</a> Nature Reviews. Urology. 17 (1), 41-61 (2020).</li>
<li>Dindo, D., Demartines, N., Clavien, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Classification+of+surgical+complications%3A+a+new+proposal+with+evaluation+in+a+cohort+of+6336+patients+and+results+of+a+survey%5BTitle%5D)+AND+%22Annals+of+Surgery%22%5BJournal%5D)">Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.</a> Annals of Surgery. 240 (2), 205-213 (2004).</li>
<li>Xylinas, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+combined+oncological+and+functional+outcomes+after+radical+prostatectomy%3A+trifecta+rate+of+achieving+continence%2C+potency+and+cancer+control--a+literature+review%5BTitle%5D)+AND+%22Urology%22%5BJournal%5D)">Evaluation of combined oncological and functional outcomes after radical prostatectomy: trifecta rate of achieving continence, potency and cancer control--a literature review.</a> Urology. 76 (5), 1194-1198 (2010).</li>
<li>Walz, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+critical+analysis+of+the+current+knowledge+of+surgical+anatomy+related+to+optimization+of+cancer+control+and+preservation+of+continence+and+erection+in+candidates+for+radical+prostatectomy%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy.</a> European Urology. 57 (2), 179-192 (2010).</li>
<li>Walz, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+critical+analysis+of+the+current+knowledge+of+surgical+anatomy+of+the+prostate+related+to+optimisation+of+cancer+control+and+preservation+of+continence+and+erection+in+candidates+for+radical+prostatectomy%3A+An+update%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: An update.</a> European Urology. 70 (2), 301-311 (2016).</li>
<li>Albisinni, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Systematic+review+comparing+Anterior+vs+Retzius-sparing+robotic+assisted+radical+prostatectomy%3A+can+the+approach+really+make+a+difference%5BTitle%5D)+AND+%22Minerva+Urology+and+Nephrology%22%5BJournal%5D)">Systematic review comparing Anterior vs Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference.</a> Minerva Urology and Nephrology. , (2021).</li>
<li>Menon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Functional+recovery%2C+oncologic+outcomes+and+postoperative+complications+after+robot-assisted+radical+prostatectomy%3A+An+evidence-based+analysis+comparing+the+Retzius+sparing+and+standard+approaches%5BTitle%5D)+AND+%22The+Journal+of+Urology%22%5BJournal%5D)">Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: An evidence-based analysis comparing the Retzius sparing and standard approaches.</a> The Journal of Urology. 199 (5), 1210-1217 (2018).</li>
<li>Olivero, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Retzius-sparing+robotic+radical+prostatectomy+for+surgeons+in+the+learning+curve%3A+A+propensity+score-matching+analysis%5BTitle%5D)+AND+%22European+Urology+Focus%22%5BJournal%5D)">Retzius-sparing robotic radical prostatectomy for surgeons in the learning curve: A propensity score-matching analysis.</a> European Urology Focus. 7 (4), 772-778 (2021).</li>
<li>Galfano, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Retzius-sparing+robot-assisted+radical+prostatectomy%3A+early+learning+curve+experience+in+three+continents%5BTitle%5D)+AND+%22BJU+International%22%5BJournal%5D)">Retzius-sparing robot-assisted radical prostatectomy: early learning curve experience in three continents.</a> BJU International. 127 (4), 412-417 (2021).</li>
<li>Galfano, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Beyond+the+learning+curve+of+the+Retzius-sparing+approach+for+robot-assisted+laparoscopic+radical+prostatectomy%3A+oncologic+and+functional+results+of+the+first+200+patients+with+%3E%2F%3D+1+year+of+follow-up%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with >/= 1 year of follow-up.</a> European Urology. 64 (6), 974-980 (2013).</li>
<li>Hoffman, K. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Patient-reported+outcomes+through+5+years+for+active+surveillance%2C+surgery%2C+brachytherapy%2C+or+external+beam+radiation+with+or+without+androgen+deprivation+therapy+for+localized+prostate+cancer%5BTitle%5D)+AND+%22JAMA%22%5BJournal%5D)">Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.</a> JAMA. 323 (2), 149-163 (2020).</li>
<li>Dalela, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+pragmatic+randomized+controlled+trial+examining+the+impact+of+the+Retzius-sparing+approach+on+early+urinary+continence+recovery+after+robot-assisted+radical+prostatectomy%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">A pragmatic randomized controlled trial examining the impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy.</a> European Urology. 72 (5), 677-685 (2017).</li>
<li>Yossepowitch, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Positive+surgical+margins+after+radical+prostatectomy%3A+a+systematic+review+and+contemporary+update%5BTitle%5D)+AND+%22European+Urology%22%5BJournal%5D)">Positive surgical margins after radical prostatectomy: a systematic review and contemporary update.</a> European Urology. 65 (2), 303-313 (2014).</li>
<li>Vale, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Adjuvant+or+early+salvage+radiotherapy+for+the+treatment+of+localised+and+locally+advanced+prostate+cancer%3A+a+prospectively+planned+systematic+review+and+meta-analysis+of+aggregate+data%5BTitle%5D)+AND+%22Lancet%22%5BJournal%5D)">Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data.</a> Lancet. 396 (10260), London, England. 1422-1431 (2020).</li>
<li>Lumen, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Safe+introduction+of+robot-assisted+radical+prostatectomy+after+a+training+program+in+a+high-volume+robotic+centre%5BTitle%5D)+AND+%22Urologia+Internationalis%22%5BJournal%5D)">Safe introduction of robot-assisted radical prostatectomy after a training program in a high-volume robotic centre.</a> Urologia Internationalis. 91 (2), 145-152 (2013).</li>
<li>Galfano, A., Secco, S., Bocciardi, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mottrie+A.+Retzius-sparing+robot-assisted+laparoscopic+radical+prostatectomy%3A+An+international+survey+on+surgical+details+and+worldwide+diffusion%5BTitle%5D)+AND+%22European+Urology+Focus%22%5BJournal%5D)">Mottrie A. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: An international survey on surgical details and worldwide diffusion.</a> European Urology Focus. 6 (5), 1021-1023 (2020).</li>
<li>Checcucci, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Precision+prostate+cancer+surgery%3A+an+overview+of+new+technologies+and+techniques%5BTitle%5D)+AND+%22Minerva+Urologica+e+Nefrologica%3A+The+Italian+Journal+of+Urology+and+Nephrology%22%5BJournal%5D)">Precision prostate cancer surgery: an overview of new technologies and techniques.</a> Minerva Urologica e Nefrologica: The Italian Journal of Urology and Nephrology. 71 (5), 487-501 (2019).</li>
<li>Grasso, A. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Posterior+musculofascial+reconstruction+after+radical+prostatectomy%3A+an+updated+systematic+review+and+a+meta-analysis%5BTitle%5D)+AND+%22BJU+International%22%5BJournal%5D)">Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis.</a> BJU International. 118 (1), 20-34 (2016).</li>
<li>Manfredi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Total+anatomical+reconstruction+during+robot-assisted+radical+prostatectomy%3A+focus+on+urinary+continence+recovery+and+related+complications+after+1000+procedures%5BTitle%5D)+AND+%22BJU+international%22%5BJournal%5D)">Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.</a> BJU international. 124 (3), 477-486 (2019).</li>
</ol>

The authors have no conflicts of interest.

During RS-RARP, the whole procedure is performed by approaching the bladder through the posterior end. Consequently, the main difference with SA-RARP is the preservation of the Retzius&#39; space. Preservation of Retzius&#39; space has several anatomical advantages7: First, the bladder is not detached from the abdominal wall and the umbilical ligaments are not transected. Therefore, the bladder remains in its anatomical position. Second, the anterior detrusor apron and puboprostatic ligaments are ...

To cure localized and selected cases of locally advanced prostate cancer, radical prostatectomy is one of the recommended treatment options1. Minimal invasive techniques (conventional laparoscopy and robot-assisted laparoscopy) have the advantage to lower blood loss, postoperative pain, and duration of hospitalization as compared to open radical prostatectomy2,3. Among the minimal invasive techniques, robot-assisted surgery combines the advantages of minimal invasive surgery with increased dexterity and freedom of movement of the surgical instruments and with 3-dimensional perioperative vision. In well-resourced countries, robot-assisted radical prostatectomy (RARP) has become the predominant mode to perform radical prostatectomy4.
Urinary incontinence, temporary or definitive, is a common side effect of radical prostatectomy, irrespective of the mode by which it has been performed5. With open (abdominal), laparoscopic, and &#34;standard&#34; anterior RARP (SA-RARP), radical prostatectomy is performed by an anterior approach in which the retropubic (Retzius&#39;) space is opened6. Thanks to the increased dexterity associated with RARP, an alternative anatomic approach is possible in which the prostate is resected through the rectovesical pouch or Douglas&#39; pouch as first described by Galfano et al.7. This posterior approach leaves the Retzius&#39; space intact (&#34;Retzius-sparing RARP&#34;; RS-RARP). The main advantage of RS-RARP appears to be a higher and faster recovery of urinary continence8. This study aims to describe in detail (as suggested by the Pasadena consensus panel9) the steps of RS-RARP supported by audiovisual material and to report on the early functional and oncological outcomes of the first cases in a single center.

<table><tbody><tr><td>adhesive tape</td><td>BSNmedical</td><td>15200028</td><td>Tensoplast</td></tr><tr><td>assistant trocar 5mm</td><td>Aesculap</td><td>EKO17R</td><td>reusable trocar</td></tr><tr><td>assistant trocar 12mm</td><td>Conmed</td><td>iAS12-120LPi</td><td>AirSeal trocar</td></tr><tr><td>barbed wire</td><td>Covidien</td><td>VLOCM0024</td><td>for vesico-urethral anastomosis</td></tr><tr><td>Cadiere forceps</td><td>Intuitive</td><td>470049</td><td>robotic instrument, grasper</td></tr><tr><td>camera 30&amp;deg;</td><td>Intuitive</td><td>470027</td><td>endoscope</td></tr><tr><td>cefazolin</td><td>Sandoz</td><td>BE217296</td><td>Belgian farmaceutical registration</td></tr><tr><td>CO2-insufflator</td><td>Conmed</td><td>AS-iFS2</td><td>AirSeal insufflator</td></tr><tr><td>Da Vinci Xi system</td><td>Intuitive</td><td>600062</td><td>robotic system</td></tr><tr><td>endobag</td><td>Covidien</td><td>173050G</td><td>Endo Catch 10mm</td></tr><tr><td>endoscopic hem-o-lok applier</td><td>Teleflex</td><td>544995T</td><td>to apply the locking clips</td></tr><tr><td>fenestrated bipolar forceps</td><td>Intuitive</td><td>470205</td><td>robotic instrument, bipolar forceps</td></tr><tr><td>Hasson cone 8mm trocar</td><td>Intuitive</td><td>470398</td><td>only at the camera trocar</td></tr><tr><td>heparin, low molecular weight (enoxaparin)</td><td>Sanofi</td><td>BE144347</td><td>Belgian farmaceutical registration</td></tr><tr><td>hydrogel coated latex transurethral catheter</td><td>Bard</td><td>D226416</td><td>Biocath</td></tr><tr><td>insufflation cable</td><td>Conmed</td><td>ASM-EVAC1</td><td>AirSeal Tri-lumen filtered tube set</td></tr><tr><td>laparoscopic grasper</td><td>Aesculap</td><td>PO235R</td><td>Atraumatic wave grasper, double action</td></tr><tr><td>large needle driver</td><td>Intuitive</td><td>470006</td><td>roboic instrument, needle driver</td></tr><tr><td>locking clip</td><td>Grena</td><td>5-13mm</td><td>Click&#039;aVplus</td></tr><tr><td>metallic clips 5mm</td><td>Aesculap</td><td>PL453SU</td><td>for vessel ligation</td></tr><tr><td>monopolar curved scissor</td><td>Intuitive</td><td>470179</td><td>robotic instrument, hot shears</td></tr><tr><td>mosquito clamp</td><td>Innovia Medical</td><td>MQC2025-D</td><td>to secure bladder suspension stitch</td></tr><tr><td>natriumlaurylsulfoacetate-sorbitol-natriumcitratedihydrate clysma</td><td>Johnson &amp;amp; Johnson Consumer BV</td><td>RVG 05069</td><td>Belgian farmaceutical registration</td></tr><tr><td>polyglactin 3.0 suture</td><td>Ethicon</td><td>V442H</td><td>stay suture bladder neck, subcutaneous sutures</td></tr><tr><td>polyglactin 1 suture</td><td>Ethicon</td><td>D9708</td><td>stay suture fascia and fascia closurie</td></tr><tr><td>povidone-iodine alcoholic solution</td><td>Mylan</td><td>BE230736</td><td>Belgian farmaceutical registration</td></tr><tr><td>robotic trocar 8mm</td><td>Intuitive</td><td>470002</td><td>standard length</td></tr><tr><td>Skin stapler</td><td>Covidien</td><td>8886803712</td><td>skin closure</td></tr><tr><td>sterile drapes robotic arms</td><td>Intuitive</td><td>470015</td><td>draping system robotic arms</td></tr><tr><td>suction-irrigation device</td><td>Geyi</td><td>GYSL-5X330</td><td>laparoscopic use by assitant</td></tr><tr><td>suspension sutures</td><td>Ethicon</td><td>628H</td><td>Ethilon 2-0 nylon suture</td></tr><tr><td>thrombo-embolus deterrent stockings</td><td>Covidien</td><td>7203</td><td>T.E.D. stockings</td></tr><tr><td>warming blanket device</td><td>3M</td><td>54200</td><td>Bear Hugger</td></tr></tbody></table>

retzius-sparing robot-assisted radical prostatectomy

Retzius-Sparing Robot-Assisted Radical Prostatectomy

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The technique is described step-by-step and further illustrated by a video to enhance reproducibility. Early oncological and functional results were evaluated. In total, 77 patients were included with a median follow-up of 11 months (range: 3-21 months). Fifty-one percent of patients had local high-risk or locally advanced prostate cancer. There were no intra-operative complications, and all high-grade complications (2.6%) were related to pelvic lymph node dissection performed concomitant with RS-RARP. Median operation time was 160 min (range: 122-265 min) and median hospital stay was 3 (range: 3-8) days. A positive surgical margin was reported in 42.9%. One-year biochemical recurrence-free survival was 90.1%. After 6 months, all patients were socially continent and after 1 year, 94.3% were fully continent. Of sexually active patients who underwent at least unilateral nerve-sparing, 43.3% were able to have sexual intercourse. This series underlines the surgical safety of performing RS-RARP by a standardized technique and confirms the beneficial effect on the early return of continence. The patient needs to be informed about the risk of a positive surgical margin.

All patients with local or locally advanced prostate cancer with a life expectancy &#62;10 years and with no anesthesiologic contra-indications were offered RS-RARP as one of the treatment options for their disease. Patients undergoing cytoreductive radical prostatectomy for metastatic prostate cancer in the context of a clinical trial or salvage radical prostatectomy were not offered RS-RARP, and patients with anterior tumors were preferably offered SA-RARP. Patients with a follow-up of fewer than 3 months were excluded...

Robot-assisted Retzius-sparing radical prostatectomy is a technique that enables to preserve urinary continence or facilitates recovery of urinary continence in the majority of patients. Patients must be informed about the risk of a positive surgical margin.

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The ...

retzius-sparing-robot-assisted-radical-prostatectomy

Research

JoVE Journal

Medicine

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