PuraBond® in Robot-Assisted Radical Prostatectomy (RARP): Exploring a Novel Haemostatic Strategy Using Self-Assembling Peptides

Introduction Haemostasis is critical during and after robot-assisted radical prostatectomy (RARP) for prostate carcinoma. While RARP offers superior outcomes compared to open and laparoscopic surgery, achieving reproducible intra- and postoperative bleeding control is essential for all approaches. Conventional methods of haemostasis in the pelvis and the prostate bed include diathermy and sutures, which may be insufficient in some cases. This report evaluates the use of PuraBond® (3D Matrix Ltd., Tokyo, Japan), a self-assembling peptide (SAP) haemostatic agent, during RARP as a novel method. Materials and methods We conducted a retrospective case series of 10 patients who underwent RARP at a tertiary National Health Service (NHS) teaching hospital between January and March 2025. Data on patient demographics, surgical approach, and follow-up outcomes were collected from institutional records. Variables recorded included patient age, perioperative parameters such as nerve-sparing status, estimated blood loss, and transfusion requirements. Overall complications and readmissions within 90 days were recorded. Urinary function was assessed using pre-operative and post-operative International Prostate Symptom Score (IPSS) scores, with continence defined as the absence of pad use. Erectile function (EF) was evaluated using preoperative and postoperative International Index of Erectile Function (IIEF) scores. The primary endpoints were intraoperative complications, especially postoperative haemostasis. Secondary endpoints included catheter removal success and urinary outcomes on follow-up. Results Ten patients (age range: 51-76 years, median age: 66 years) underwent RARP with intraoperative application of PuraBond®. No intraoperative complications were observed, and PuraBond® achieved effective haemostasis in all cases. No patients experienced postoperative bleeding or required a blood transfusion. Trial without catheter (TWOC) was successful in all patients, typically at the first follow-up visit (median: 13 days; range: 12-15 days). At the initial postoperative review (mean: 12 days), most patients reported either mild or no urinary incontinence. Outcomes at the second follow-up (mean: 48 days) demonstrated continued recovery with low complication rates maintained. No readmissions nor adverse events were reported within the 90-day postoperative period. Conclusion This study presents the first reported case series evaluating PuraBond® as an adjunct haemostatic agent in RARP. The results suggest consistent haemostatic efficacy and favourable early postoperative outcomes across a patient cohort. Prospective controlled studies are warranted to compare PuraBond® with alternative methods of haemostasis.