To explore the technical essentials of robot-assisted radical prostatectomy via posterior and completely intrafascial for organ-confined prostate cancer, and to evaluate the oncological and functional outcomes.

Fifteen prostate cancer patients with T_1-2bN₀M₀ were scheduled for robot-assisted radical prostatectomy via posterior and completely intrafascial approach, and their international index of erectile function (IIEF) were performed before operation. All patient was placed in a supine position and the robotic system was established. Firstly, expose the Douglas fossa, free bilateral vas deferens and seminal vesicles, blunt dissection of the Denonvillier fascia, severed lateral ligament and visceral pelvic fascia, then exposed and disconnected urethra, continuous suture bladder neck urethra. Perioperative complications and functional outcome data were recorded. All patients were regularly followed up for tPSA testing, daily urine pads and IIEF-5 scores.

All of the 15 patients were successfully completed the operations. The median (range) operation time was 86(65-116) min, and estimated blood loss was 20 (10-60) ml, and no serious complications occurred. Postoperative pathology was <pT_2c, Gleason score <8, no cases of positive surgical margins, and no biochemical recurrence (BCR) in postoperative follow-up. Catheter were removed after a median (range) time of 7(6-8) d, 13 patients were immediately continent (0 pads/d), and two patients had mild incontinence (2-3 pads/d). All patients were observed as continent within next two weeks. Nine patients achieved a satisfactory erection at 6 months postoperatively, with an IIEF-5 score >18.

Robot-assisted radical prostatectomy via posterior and completely intrafascial approach is technically feasible for patients with low-risk localized prostate cancer and demonstrates promising functional outcomes regarding continence and potency.