Feasibility and early outcomes of the modified hood technique in laparoscopic versus robot-assisted radical prostatectomy: a single-center experience

To preliminarily assess the feasibility and short-term outcomes of a modified Hood technique via an extraperitoneal approach in RARP and LRP, focusing on urinary continence recovery. We retrospectively analyzed 66 patients with localized prostate cancer who underwent single-surgeon extraperitoneal radical prostatectomy between September 2023 and July 2025, including 30 RARP and 36 LRP cases. The modified Hood technique emphasized preservation of the anterior prostatic stroma, endopelvic fascia, detrusor apron, and periurethral supporting structures. Perioperative, early pathological, and continence outcomes were compared. Baseline characteristics were similar between groups. RARP showed numerically shorter surgeon active operating time, lower estimated blood loss, and shorter drainage duration, although these differences were not statistically significant. PSM rates were 13.3% and 16.7% in the RARP and LRP groups, respectively. Median oncological follow-up was 11.0 months and 9.5 months, respectively; therefore, biochemical recurrence findings were considered preliminary. Immediate continence was numerically higher in the RARP group [66.7% (95% CI, 48.8–80.8) vs. 44.4% (95% CI, 29.5–60.4), p = 0.05], while continence rates at 3 and 6 months were high in both groups. The modified Hood technique appeared technically feasible in both RARP and conventional LRP via an extraperitoneal approach. However, given the limited sample size, insufficient statistical power, and immature oncological follow-up, these findings should be interpreted as preliminary rather than evidence of equivalence. Larger prospective studies with longer follow-up are needed.