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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Pubovesical Complex-Sparing Under Hypothermia During Robotic-Assisted Laparoscopic Radical Prostatectomy: A Single-Institution Case Series

by
Chin-Heng Lu
1,2,3,
Min-Che Tung
1,4,
Chu-Shan Yuan
5,
Yi-Sheng Lin
1,
Li-Hua Huang
1,2,3,
Wei-Chun Weng
1,
Chao-Yu Hsu
1,
Tang-Yi Tsao
6,
Yen-Chuan Ou
1,2,* and
Chia-Che Chang
2,3,7,8,9,10,11,*
1
Division of Urology, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, Taichung City 435403, Taiwan
2
Rong Hsing Translational Medicine Research Center, National Chung Hsing University, Taichung City 402204, Taiwan
3
Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung City 402204, Taiwan
4
Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356006, Taiwan
5
Division of Urology, Department of Surgery, Li’s Hospital Daja, Taichung City 437704, Taiwan
6
Departments of Pathology, Tungs’ Taichung Metro Harbor Hospital, Taichung City 435403, Taiwan
7
Department of Life Sciences, National Chung Hsing University, Taichung 402202, Taiwan
8
Graduate Institute of Biomedical Sciences, Rong Hsing Translational Medicine Research Center, The iEGG and Animal Biotechnology Research Center, National Chung Hsing University, Taichung 402202, Taiwan
9
Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 413305, Taiwan
10
Department of Medical Research, China Medical University Hospital, Taichung 404327, Taiwan
11
Traditional Herbal Medicine Research Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
 
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Authors to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(24), 8759; https://doi.org/10.3390/jcm14248759 (registering DOI)
Submission received: 21 October 2025 / Revised: 20 November 2025 / Accepted: 1 December 2025 / Published: 10 December 2025
(This article belongs to the Special Issue Robotic Urological Surgery: Clinical Updates for Better Outcomes)
Versions Notes

Abstract

Background/Objectives: Functional continence and potency outcomes are paramount for the pentafecta of robotic-assisted laparoscopic radical prostatectomy (RARP). We describe a modified approach of the pubovesical complex (PVC)-sparing technique under hypothermia for better continence and potency preservation. Methods: This is a retrospective single-institution case series. Thirty-three PVC-sparing RARP procedures under hypothermia were performed in patients with clinically localized prostate cancer by the same experienced surgeon. The method includes four principles: (1) modified PVC-sparing technique, according to Richard Gaston et al., (2) the use of near-infrared fluorescence technology and indocyanine green to identify the benchmark artery of the neurovascular bundle and blood supply for the PVC, (3) accessory pudendal artery preservation, and (4) hypothermia to reduce tissue edema. Functional outcomes, including continence, potency, and other surgical findings, are presented. This is a feasibility case series, not a comparative or hypothesis-testing study. Results: This study enrolled 33 cases from 15 April 2020 to 31 December 2022. Four patients had positive surgical margins. The urinary continence rate was 100% after Foley removal at a mean of 6.6 days. The potency rate was 74% (17/23) at 6 months and 91.3% (21/23) at 12 months. The inclusion of a small sample of patients from a single hospital and the selection of patient conditions were the study limitations. Conclusions: The modified approach we described is technically feasible, and it can expedite the restoration of urinary function and potency preservation. No severe complications occurred, and patients achieved good oncological outcomes.
Keywords: robotic urological surgery; clinical outcomes; surgical techniques; patient-reported outcomes robotic urological surgery; clinical outcomes; surgical techniques; patient-reported outcomes

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MDPI and ACS Style

Lu, C.-H.; Tung, M.-C.; Yuan, C.-S.; Lin, Y.-S.; Huang, L.-H.; Weng, W.-C.; Hsu, C.-Y.; Tsao, T.-Y.; Ou, Y.-C.; Chang, C.-C. Pubovesical Complex-Sparing Under Hypothermia During Robotic-Assisted Laparoscopic Radical Prostatectomy: A Single-Institution Case Series. J. Clin. Med. 2025, 14, 8759. https://doi.org/10.3390/jcm14248759

AMA Style

Lu C-H, Tung M-C, Yuan C-S, Lin Y-S, Huang L-H, Weng W-C, Hsu C-Y, Tsao T-Y, Ou Y-C, Chang C-C. Pubovesical Complex-Sparing Under Hypothermia During Robotic-Assisted Laparoscopic Radical Prostatectomy: A Single-Institution Case Series. Journal of Clinical Medicine. 2025; 14(24):8759. https://doi.org/10.3390/jcm14248759

Chicago/Turabian Style

Lu, Chin-Heng, Min-Che Tung, Chu-Shan Yuan, Yi-Sheng Lin, Li-Hua Huang, Wei-Chun Weng, Chao-Yu Hsu, Tang-Yi Tsao, Yen-Chuan Ou, and Chia-Che Chang. 2025. "Pubovesical Complex-Sparing Under Hypothermia During Robotic-Assisted Laparoscopic Radical Prostatectomy: A Single-Institution Case Series" Journal of Clinical Medicine 14, no. 24: 8759. https://doi.org/10.3390/jcm14248759

APA Style

Lu, C.-H., Tung, M.-C., Yuan, C.-S., Lin, Y.-S., Huang, L.-H., Weng, W.-C., Hsu, C.-Y., Tsao, T.-Y., Ou, Y.-C., & Chang, C.-C. (2025). Pubovesical Complex-Sparing Under Hypothermia During Robotic-Assisted Laparoscopic Radical Prostatectomy: A Single-Institution Case Series. Journal of Clinical Medicine, 14(24), 8759. https://doi.org/10.3390/jcm14248759

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