Finger dissection open radical prostatectomy offers comparable early functional results with robotic prostatectomy in the robotic era: a comparative study

Apical dissection is a crucial step of radical prostatectomy (RP) for postoperative functional outcomes. Robot-assisted laparoscopic RP (RALRP) represents a good visualization for this stage and bleeding during ligation of dorsal vein complex (DVC) is a challenging problem in open RP (ORP). In our study, the results of finger dissection technique in open RP were evaluated and compared with RALRP. We retrospectively reviewed 184 patients who underwent RP for clinically localized prostate cancer. Blunt finger dissection technique performed for ligation of DVC in ORP and patients were divided into two groups according to the surgical method (Group 1:RALRP; Group 2:FD-ORP - Finger dissection-ORP). The primary outcomes were continence status and erectile functions. Ninety-two patients in each group were enrolled in the study. Demographics, operative outcomes, preoperative and postoperative oncological data were also recorded. Demographics and preoperative data were similar. There is no statistically difference between groups in terms of operation time, blood loss, transfusion rates, hospitalization time, and peri- and postoperative complications (p > 0.05). Continence rates (82.6% vs. 89.1%, p = 0.439) and erectile functions (mean IIEF: 10.62 vs. 11.34, p = 0.107) showed no statistically significant difference between FD-ORP and RALRP in the first year after surgery. Finger dissection of the DVC during ORP is a simple and feasible technique that provides the correct plane on the urethra, resulting in better apical dissection with effective hemostasis. Although it shows similar early functional results as RALRP, more research is needed. These findings suggest that FD-ORP may serve as a viable surgical option in settings where robotic technology is inaccessible.