Safety and Outcomes of Intraoperative Ventriculoperitoneal Shunt Clamping During Robotic-assisted Radical Prostatectomy: Retrospective Cohort Analysis.

Background/aim: This study aimed to assess the safety and outcomes of intraoperative ventriculoperitoneal (VP) shunt clamping during robotic-assisted radical prostatectomy (RaRP) in patients with VP shunts.

Patients and methods: A retrospective analysis of nine patients with VP shunts who underwent RaRP between February 2016 and October 2024 was conducted. Data on preoperative prostate-specific antigen (PSA) levels, surgical margins, complications, and follow-up durations were collected. Patients were stratified into subgroups based on PSA levels (≤10 vs. >10 ng/ml), operative time (<200 vs. ≥200 min), and estimated blood loss (<150 vs. ≥150 ml). Outcomes were analyzed using descriptive statistics, focusing on PSA trends, biochemical recurrence, and VP shunt functionality.

Results: All procedures were completed without intraoperative or VP shunt-related complications. The median operative time was 180 min (range=180-330 min), and the median estimated blood loss was 170 ml (range=50-700 ml). Most patients showed significant PSA suppression, with a median PSA of <0.008 ng/ml at one year. Patients with initial PSA levels >10 ng/ml had greater variability in PSA trends, including persistent elevation or biochemical recurrence, whereas those with PSA levels ≤10 ng/ml had stable outcomes. No differences in oncological outcomes were noted based on operative time or blood loss. Median follow-up was 54 months (range=2-105 months).

Conclusion: VP shunt clamping during RaRP is safe and effective, with favorable surgical and oncological outcomes and preserved shunt functionality. Larger studies are needed to confirm these findings and establish standardized protocols.