Randomized comparison of extraperitoneal and transperitoneal access for robot-assisted radical prostatectomy.
ABSTRACT 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.
- Korean journal of urology 01/2009; 50(3).
- [Show abstract] [Hide abstract]
ABSTRACT: Over the years, several surgical modifications have been incorporated into radical prostatectomy in order to improve the surgical outcome. Despite the rapid dissemination of robot-assisted laparoscopic prostatectomy (RALP) through the urologic community, comparative studies on the practicality of RALP compared to open radical prostatectomy (OP) are lacking. Thus, it remains difficult to draw any conclusions regarding cancer control and postoperative morbidity. This review will introduce the evolution of surgical technique and the current status of RALP in relation to OP in the management of localized prostate cancer focusing on the perioperative, oncological and functional outcomes. Based on the review of literatures, perioperative outcomes, such as blood loss, transfusion rates, hospitalization duration and complication rates, all favored RALP. The positive surgical margin rates of RALP were similar to those of OP with regard to the oncological outcomes. With regard to the functional outcomes, OP and RALP also showed similar continence and potency rates. However, refinements in technique employed during RALP have improved the early return of continence postoperatively. Although OP remains the gold standard treatment in localized prostate cancer, robotic surgery and continued technical advancements will ultimately improve patient outcomes. However, further prospective randomized comparative clinical trials with a long-term follow-up utilizing validated questionnaire are needed to prove the superiority of either surgical approach in terms of functional and oncological outcomes. In addition, RALP technique will need a substantial decrease in the cost of the robotic system to achieve wider global acceptance and application.Journal of the Korean Medical Association 01/2010; 53(2). · 0.18 Impact Factor
- [Show abstract] [Hide abstract]
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; · 1.19 Impact Factor