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<p>Robotic-assisted laparoscopic prostatectomy (RALP) is widely considered the standard surgical approach for localized prostate cancer, offering reduced blood loss, shorter hospitalization, and favorable functional and oncological outcomes compared with open and conventional laparoscopic techniques. Optimizing intraoperative hemostasis may further enhance these results. This study evaluates the association between temporary clamping of the internal iliac artery—the main prostatic arterial supply—on estimated blood loss (EBL), functional outcomes (urinary and erectile function), and cancer recurrence. A total of 523 patients undergoing RALP between January 2015 and December 2022 were retrospectively analyzed. Patients were divided into two groups: clamping (<i>n</i> = 277), in whom the internal iliac artery was temporarily clamped with a bulldog clamp, and no-clamping (<i>n</i> = 246). The significance threshold was set at <i>p</i> &lt; 0.05. Patients in the clamping group had significantly lower EBL compared to the no-clamping group (406 mL vs. 645 mL; <i>p</i> &lt; 0.001). Rates of negative surgical margins were higher with clamping (98.2% vs. 94.3%; <i>p</i> = 0.024). Recurrence was less frequent in the clamping group, including local (0.72% vs. 2.4%), PSA (1.44% vs. 5.7%), and distant recurrence (0% vs. 0.8%; <i>p</i> = 0.004). Overall recurrence-free survival was 97.8% with clamping versus 91% without. Continence (0–1 pad/day) and erectile function scores were similar between groups. Median follow-up was comparable (57.5 vs. 58.6 months). Internal iliac artery clamping during RALP was associated with reduced blood loss and more favorable oncological outcomes, without adverse effects on functional recovery.</p>

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The impact of internal iliac artery clamping on blood loss, functional outcomes, and cancer control during robotic-assisted radical prostatectomy

  • 期刊论文

  • 发表日期：

    2025年11月1日

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  • Mohammed Al-Ogaili,
  • Arjun Venkatesh,
  • Japnit Dham,
  • Mina Al-Ogaili,
  • Ahmed Rabie,
  • Maida Bada,
  • Carme Mir,
  • Esther Kim,
  • Petitti Tommasangelo,
  • Ahmed Eraky,
  • Zachary Dovey,
  • Osama Zaytoun,
  • Maurizio Buscarini

摘要

Robotic-assisted laparoscopic prostatectomy (RALP) is widely considered the standard surgical approach for localized prostate cancer, offering reduced blood loss, shorter hospitalization, and favorable functional and oncological outcomes compared with open and conventional laparoscopic techniques. Optimizing intraoperative hemostasis may further enhance these results. This study evaluates the association between temporary clamping of the internal iliac artery—the main prostatic arterial supply—on estimated blood loss (EBL), functional outcomes (urinary and erectile function), and cancer recurrence. A total of 523 patients undergoing RALP between January 2015 and December 2022 were retrospectively analyzed. Patients were divided into two groups: clamping (n = 277), in whom the internal iliac artery was temporarily clamped with a bulldog clamp, and no-clamping (n = 246). The significance threshold was set at p < 0.05. Patients in the clamping group had significantly lower EBL compared to the no-clamping group (406 mL vs. 645 mL; p < 0.001). Rates of negative surgical margins were higher with clamping (98.2% vs. 94.3%; p = 0.024). Recurrence was less frequent in the clamping group, including local (0.72% vs. 2.4%), PSA (1.44% vs. 5.7%), and distant recurrence (0% vs. 0.8%; p = 0.004). Overall recurrence-free survival was 97.8% with clamping versus 91% without. Continence (0–1 pad/day) and erectile function scores were similar between groups. Median follow-up was comparable (57.5 vs. 58.6 months). Internal iliac artery clamping during RALP was associated with reduced blood loss and more favorable oncological outcomes, without adverse effects on functional recovery.