A Comparison of Extraperitoneal and Intraperitoneal Approaches for Robotic Prostatectomy
ABSTRACT Objectives. This study compared oncologic and health-related quality-of-life outcomes among patients undergoing intraperitoneal or extraperitoneal robotic prostatectomy. Methods. Of 215 patients undergoing robotic prostatectomy, the approach was intraperitoneal in 48 and extraperitoneal in 167. Cancer control was evaluated using margin status. Recovery after surgery and functional health was assessed using the Convalescence and Recovery Evaluation and Expanded Prostate Cancer Index Composite questionnaires, respectively. Results. Positive surgical margin rates were similar between approaches (14% extraperitoneal, 10% intraperitoneal; P = .63). Functional outcomes were slightly improved for those with the extraperitoneal approach (ie, higher urinary irritation/obstruction scores at 3 months). The extraperitoneal group demonstrated higher activity (91.8 vs 83.3, P = .03) and cognitive scores (94.9 vs 91.7, P = .04) at 6 weeks as well as higher gastrointestinal scores at 2 weeks (94.2 vs 90.8, P = .05). Conclusions. These data support efforts to broaden the adoption of the extraperitoneal approach for robotic prostatectomy.
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ABSTRACT: Abstract Objective: To conduct a meta-analysis of studies that compared transperitoneal (TP) and extraperitoneal (EP) robot-assisted radical prostatectomy (RARP). Materials and Methods: PubMed, the Cochrane Library, and EMBASE online databases were searched for studies released prior to June 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Scottish Intercollegiate Guidelines Network Methodology Checklist for case-control and cohort studies was applied. Results: One randomized controlled trial and five case-control studies were identified that met the inclusion criteria. Within these studies, 530 patients underwent EP-RARP, and 312 patients underwent TP-RARP. Operating room (OR) time for EP was shorter than for TP (mean difference, -25.551; 95% confidence interval [CI] -41.668 to -9.434; P=.002). For estimated blood loss, there was no significant difference between EP and TP (mean difference, -12.111; 95% CI -44.087 to 19.865; P=.458). There was a statistical difference in length of stay (LOS) between EP and TP patients (mean difference, -0.488; 95% CI -0.964 to -0.012; P=.044). There was no significant difference in margin positivity between EP and TP (odds ratio=1.023; 95% CI 0.656-1.573; P=.918). In complications including grade 2 or more than 2, there was also no difference between EP and TP (odds ratio=0.610; 95% CI 0.341-1.089; P=.094). Conclusions: This meta-analysis suggests that perioperative parameters, including OR time and LOS, may be more favorable for EP-RARP than for TP-RARP. However, the oncologic outcome of margin positivity did not demonstrate a significant difference between the EP and TP approaches.Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2013; DOI:10.1089/lap.2013.0265 · 1.19 Impact Factor