Best practice in preoperative surgical planning for robotic-assisted radical prostatectomy: a European consensus statement

Abstract

Background and objective: The surgical plan in robotic-assisted radical prostatectomy (RARP) aims to achieve optimal perioperative, oncological, and functional outcomes by recommending the extent of resection and use of function sparing techniques. However, there is a lack in high-level evidence on the optimal process to define the plan preoperatively. We therefore undertook a consensus exercise to develop the best practice statement to supplement evidence-based guidelines.

Methods: A consensus exercise was undertaken using a modified RAND/University of California Los Angeles approach. Consensus was a priori defined as ≥75% agreement/disagreement. A total of 101 statements were developed by the steering group based on a previously published systematic review and were reviewed in three rounds by 14 panellists.

Key findings and limitations: Overall, 73 statements reached consensus and 34 reached consensus across six domains. The process concluded that a preoperative surgical plan is essential prior to undertaking any RARP and will facilitate the optimal execution of surgery, as it provides the best available information to the surgeon to refine the technique and potentially improve oncological, functional, and perioperative outcomes.

Conclusions and clinical implications: The consensus statements draw out the best practices in the surgical planning process and can assist surgeons in standardising their approach. Gaps (areas of nonconsensus) have also been identified that can direct future work.