Randomized Comparison of Extraperitoneal and Transperitoneal Access for Robot-Assisted Radical Prostatectomy

Department of Urology, University of Rochester, Rochester, New York 14642, USA.
Journal of Endourology (Impact Factor: 1.71). 11/2007; 21(10):1199-202. DOI: 10.1089/end.2007.9906
Source: PubMed


Although extraperitoneal robot-assisted radical prostatectomy (RARP) is gaining popularity, the majority of these procedures are performed transperitoneally. The purpose of this study was to compare the transperitoneal and extraperitoneal approaches for RARP.
We randomized 62 consecutive patients undergoing RARP into two equal groups according to the route of access. The groups were evaluated for age, body mass index (BMI), preoperative serum prostate specific antigen (PSA) concentration, total operating time, estimated blood loss, specimen weight, pathologic Gleason score and stage, intraoperative and postoperative complications, and surgical-margin status.
No significant differences were noted the extraperitoneal and transperitoneal groups with respect total operative time (181 v 191 minutes), blood loss (199 v 163 mL), pathologic Gleason score (6.6 v 6.7), specimen weight (53 v 48 g), or positive-margin status (0 v 1 patient). There were no significant differences in age (56 v 59 years) or PSA (7.8 v 6.1 ng/dL). However, the BMI was significantly higher in the extraperitoneal group (29.8 v 26.5 kg/m(2); P < 0.01). The only complication in the study was a urine leak, which occurred in the transperitoneal group and was managed conservatively.
There were no significant differences in operative parameters in the two groups. Choice of access should be based on patient characteristics as well as surgeon preference. Patients who have had abdominal operations are best suited for the extraperitoneal route. Surgeons should be familiar with both approaches in order to provide patients with the best care.

1 Follower
4 Reads
  • Source
    • "The latter can reduce the range of robotic arms motion especially when a 4-arm da Vinci surgical system is used. Still, with proper modifications in trocar positioning extraperitoneal robot-assisted laparoscopic prostatectomy can offer a similar clinical outcome as the intraperitoneal approach rendering the selection of route a matter of surgeons preference based on his experience and expert [34, 35]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Laparoscopic extraperitoneal radical prostatectomy (LERP) is considered the standard care treatment option for the management of localized and locally advanced prostatic cancer (PCa) in many institutes worldwide. In this work, the main advantages and disadvantages of LERP approach are reviewed with regard to its outcomes, the complication management, the learning curve, and the extend of pelvic lymph node dissection (PLND). It is concluded that LERP demonstrates comparable cancer control, urinary continence, and potency outcomes with the open and the robot-assisted radical prostatectomy, while offering advantages in complication management in comparison to the transperitoneal approach. Learning curve of LERP is considered long and stiff and significantly affects perioperative outcomes and morbidity, cancer control, and functional results. Thus, close mentoring especially in the beginning of the learning curve is advised. Finally, LERP still has a role in the limited or modified PLND offered in intermediate risk PCa patients.
    09/2011; 2011:150978. DOI:10.1155/2011/150978
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the feasibility and safety of the extraperitoneal robotic radical prostatectomy (ERP), we compared the results of transperitoneal robotic radical prostatectomy (TRP) with those of ERP performed by a single surgeon.
    Korean journal of urology 01/2009; 50(3). DOI:10.4111/kju.2009.50.3.251
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Laparoscopic radical prostatectomy is an alternative to open prostatectomy in the surgical management of prostate cancer. The introduction of surgical robot to assist laparoscopic surgery served as a mechanical device to enhance the laparoscopic skills and improve surgical maneuverability with enhanced visual systems and the multi-axis articulating instruments. This review will introduce the evolution of surgical technique and current status of robotic-assisted laparoscopic prostatectomy.
    Korean journal of urology 01/2009; 50(2):97. DOI:10.4111/kju.2009.50.2.97
Show more