Exploring the Ethical Gray Zone of Adopting New Surgical Techniques: The Case of Retzius-Sparing Radical Prostatectomy.

Developing, practicing, and implementing novel surgical techniques is imperative for all surgical specialties, but the differences between minor variations, major variations requiring specific informed consent, and human experimentation can sometimes be difficult for surgeons and institutional review boards (IRB) to establish. Retzius-sparing prostatectomy is a technical modification of conventional prostatectomy, involving substantial changes in surgical steps and anatomic landmarks, with reported improvements in some early outcomes at the cost of a significant learning curve and some uncertainty in long-term oncologic outcomes. Here, we present a review of the ethical considerations of developing new surgical techniques and how they should apply to Retzius-sparing prostatectomy. The need for special informed consent when a surgeon begins to adopt this approach and the need for IRB revision when collecting outcomes for publication.