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Peer-reviewedCC BY 4.0Journal of Robotic Surgery

How i do it: a survey of practice patterns in robot-assisted radical prostatectomy

  • Narmina Khanmammadova1
  • Johnny Wang1
  • Tuan Thanh Nguyen2
  • Dat Tien Nguyen3
  • Mohammad Abubakr4
  • Jade Vanta1
  • Kristene Myklak1
  • Daniel Jiang5
  • Sohrab N. Ali1
  • Jacob Basilius1
  • Mohammed Shahait1
  • David I. Lee1
5 affiliations
  1. 1Department of Urology, University of California, 3800 W Chapman Ave, Suite 7200, Orange, Irvine, CA 92868 USA
  2. 2Department of Urology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
  3. 3Department of Urological Oncology Surgery, Binh Dan Hospital, Ho Chi Minh, Vietnam
  4. 4School of Medicine, University of California, Riverside, CA USA
  5. 5Department of Urology, Division of Urologic Oncology, City of Hope Comprehensive Cancer Center, CA, USA
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Abstract

Despite the global availability and utilization of robot-assisted radical prostatectomy (RARP), it remains a technically complex operation, with wide variation in training paradigms, surgical technique, and perioperative management. This study examines international RARP practices and aims to identify trends and gaps in clinical practice. A multiple-choice questionnaire consisting of 32 questions was distributed between January and July 2023. A total of 102 responses were received. Responses with ≥ 5 questions with missing data (n = 8) were excluded. Among 94 participants, 91.5% were male, 69.1% practiced outside the United States (US), and 72.3% were fellowship-trained. Most surgeons (79.8%) reported performing ≥ 3 RARPs monthly. About 75% of surgeons reported performing ≥ 90% of their radical prostatectomies (RP) robotically. Seven (7.45%) respondents who reported performing RPs only via laparoscopic or open approach were excluded from subsequent analyses. Regarding the surgical technique, transperitoneal anterior approach was the most preferred (62.1%). For nerve-sparing, the combined antegrade-retrograde approach (43.7%) and the antegrade-only approaches (36.8%) were most common. Approximately half of respondents (51.7%) preferred cut-and-suture ligation for dorsal venous complex control. For pelvic lymph node dissection, standard (44.8%) or limited (29.9%) templates were preferred over the extended (24.1%) template. The most common method for vascular control was clips for vascular pedicle ligation (79.3%). Of the continence-preserving techniques, most respondents agreed on the importance of maximal urethral length preservation (93.1%), bladder neck preservation (80.5%), and posterior reconstruction (64.4%). Postoperatively, most surgeons endorsed early mobilization (92%), early oral nutrition (85.1%), and non-opioid oral analgesia (57.5%). All US-based surgeons reported discharging ≥ 70% of patients on postoperative day 1, whereas discharge patterns varied among non-US surgeons. There are significant global variations in the practice of RARP. These findings point to the potential utility of consensus-driven, evidence-based guidelines to optimize RARP practices worldwide.

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Cite

BibTeXRIS
BibTeX
@article{khanmammadova2026survey,
  title = {{How i do it: a survey of practice patterns in robot-assisted radical prostatectomy}},
  author = {Narmina Khanmammadova and Johnny Wang and Tuan Thanh Nguyen and Dat Tien Nguyen and Mohammad Abubakr and Jade Vanta and Kristene Myklak and Daniel Jiang and Sohrab N. Ali and Jacob Basilius and Mohammed Shahait and David I. Lee},
  journal = {Journal of Robotic Surgery},
  year = {2026},
  month = oct,
  doi = {10.1007/s11701-026-04080-3},
  url = {https://doi.org/10.1007/s11701-026-04080-3},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - How i do it: a survey of practice patterns in robot-assisted radical prostatectomy
AU  - Narmina Khanmammadova
AU  - Johnny Wang
AU  - Tuan Thanh Nguyen
AU  - Dat Tien Nguyen
AU  - Mohammad Abubakr
AU  - Jade Vanta
AU  - Kristene Myklak
AU  - Daniel Jiang
AU  - Sohrab N. Ali
AU  - Jacob Basilius
AU  - Mohammed Shahait
AU  - David I. Lee
PY  - 2026
DA  - 2026/10/27
JO  - Journal of Robotic Surgery
DO  - 10.1007/s11701-026-04080-3
UR  - https://doi.org/10.1007/s11701-026-04080-3
AB  - Despite the global availability and utilization of robot-assisted radical prostatectomy (RARP), it remains a technically complex operation, with wide variation in training paradigms, surgical technique, and perioperative management. This study examines international RARP practices and aims to identify trends and gaps in clinical practice. A multiple-choice questionnaire consisting of 32 questions was distributed between January and July 2023. A total of 102 responses were received. Responses with ≥ 5 questions with missing data (n = 8) were excluded. Among 94 participants, 91.5% were male, 69.1% practiced outside the United States (US), and 72.3% were fellowship-trained. Most surgeons (79.8%) reported performing ≥ 3 RARPs monthly. About 75% of surgeons reported performing ≥ 90% of their radical prostatectomies (RP) robotically. Seven (7.45%) respondents who reported performing RPs only via laparoscopic or open approach were excluded from subsequent analyses. Regarding the surgical technique, transperitoneal anterior approach was the most preferred (62.1%). For nerve-sparing, the combined antegrade-retrograde approach (43.7%) and the antegrade-only approaches (36.8%) were most common. Approximately half of respondents (51.7%) preferred cut-and-suture ligation for dorsal venous complex control. For pelvic lymph node dissection, standard (44.8%) or limited (29.9%) templates were preferred over the extended (24.1%) template. The most common method for vascular control was clips for vascular pedicle ligation (79.3%). Of the continence-preserving techniques, most respondents agreed on the importance of maximal urethral length preservation (93.1%), bladder neck preservation (80.5%), and posterior reconstruction (64.4%). Postoperatively, most surgeons endorsed early mobilization (92%), early oral nutrition (85.1%), and non-opioid oral analgesia (57.5%). All US-based surgeons reported discharging ≥ 70% of patients on postoperative day 1, whereas discharge patterns varied among non-US surgeons. There are significant global variations in the practice of RARP. These findings point to the potential utility of consensus-driven, evidence-based guidelines to optimize RARP practices worldwide.
SN  - 1863-2483
SN  - 1863-2491
ER  -