3D Laparoscopic Radical Prostatectomy: The Romolo Hospital Experience

360-patient Italian series reports 92.5% continence and 83% erectile function recovery at 6-12 months with 3D laparoscopy, no robotic platform

Journal: Journal of Laparoendoscopic & Advanced Surgical Technologies Part A | Published: 2026-03-01 | Type: Retrospective cohort | PMID: 41765869 Authors: Lauria J et al., all from Unit of Urology, Romolo Hospital SRL, Rocca di Neto (KR), Italy Funding/COI: Not listed for either

Summary

A single Italian center reports functional and oncological outcomes for 360 men who underwent 3D transperitoneal laparoscopic radical prostatectomy (3D T-LRP) between 2018 and 2022. All cases used a standardized technique by two experienced teams, paired with immediate pelvic floor rehabilitation post-catheter removal. The headline number — 92.5% continence at 6-12 months — sounds impressive, but without a comparison arm, it's a datapoint from one team at one hospital, not a verdict on the technology.

Claims

• Median operative time: 180 minutes (IQR: 150–210)
• Pelvic lymph node dissection performed in 44.2% of cases
• Positive surgical margins: 15% overall
• Continence (defined as 0–1 pad/day): 75.8% at 1 week, 83.4% at 3 months, 92.5% at 6–12 months post-catheter removal
• Median pad weight dropped from 350 g at baseline to 50 g at follow-up
• In the nerve-sparing subgroup: median IIEF-5 score 18 (IQR: 16–20) at 6–12 months; 83% achieved IIEF-5 ≥16
• Overall complication rate: 10.3%; zero Clavien-Dindo grade ≥IIIb events

Study Quality

This is a retrospective, single-center, single-arm case series — the weakest study design that still produces numbers worth noting. There is no control group, no randomization, and no comparison to robotic-assisted prostatectomy (RARP) or conventional 2D laparoscopy. The authors define continence as 0–1 pads/day, which is a widely used but permissive threshold that inflates continence rates compared to studies requiring zero pad use. Erectile function data is limited to the nerve-sparing subgroup without reporting what proportion of the 360 patients received nerve sparing, making the IIEF-5 figures impossible to interpret at the population level.

Outcomes were prospectively logged into an institutional database but analyzed retrospectively — a setup that is vulnerable to selection effects and documentation gaps. No biochemical recurrence or long-term oncological follow-up data are reported, so this paper says nothing about whether the cancer was actually controlled.

Red Flags

• No comparison arm: claims 3D-LRP is an "alternative to robotic surgery" but provides no head-to-head data
• Funding and conflicts of interest both unlisted — concerning given the technology-advocacy framing of the conclusion
• Positive surgical margin rate of 15% not benchmarked against published RARP or open series
• Nerve-sparing subgroup size not reported; erectile function denominator is unknown
• No biochemical recurrence, PSA follow-up, or survival data — oncological "safety" claim is unsupported beyond margin status
• Continence definition (0–1 pad/day) chosen to favor higher rates; no sensitivity analysis with stricter definition
• All authors from the same hospital that performed all the procedures — no external validation

Strengths

• 360 patients over 5 years is a respectable n for a single-center laparoscopy series
• Standardized operative protocol and two experienced teams reduce within-study variability
• Structured pelvic floor rehabilitation protocol immediately post-catheter removal is a concrete and replicable element
• Complication rate and Clavien-Dindo grading reported systematically

Verdict

This paper documents what one experienced Italian team can achieve with 3D laparoscopy for localized prostate cancer — and those numbers are not embarrassing. But it is fundamentally a case series dressed up in comparative language. The conclusion that 3D-LRP is a viable "alternative to robotic surgery" is stated, not demonstrated. No robot arm, no randomization, no long-term oncological data, no disclosed funding. Useful as a benchmarking reference if you're already doing 3D laparoscopy; useless as evidence that you should switch from RARP.