Brief Article
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World J Clin Urol. Jul 24, 2013; 2(2): 3-9
Published online Jul 24, 2013. doi: 10.5410/wjcu.v2.i2.3
Extraperitoneal robot-assisted radical prostatectomy: Comparison with transperitoneal technique
Chris Anderson, Ben Ayres, Rami Issa, Matthew Perry, Evangelos Liatsikos, Jens-Uwe Stolzenburg, Khurshid R Ghani
Chris Anderson, Ben Ayres, Rami Issa, Matthew Perry, Department of Urology, St George’s Hospital, St George’s Healthcare NHS Trust, London SW17 0JT, United Kingdom
Evangelos Liatsikos, Department of Urology, University of Patras School of Medicine, 26500 RIO Patras, Greece
Jens-Uwe Stolzenburg, Department of Urology, University of Leipzig, 04103 Leipzig, Germany
Khurshid R Ghani, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, United States
Author contributions: Anderson C and Ghani KR contributed to study idea and conception; Anderson C, Ayres B and Stolzenburg JU contributed to manuscript preparation; Anderson C, Liatsikos E and Stolzenburg JU contributed to surgical technique innovation; Anderson C, Issa R, Perry M, Liatsikos E, Stolzenburg JU and Ghani KR contributed to editing and revision; Anderson C contributed to supervision.
Correspondence to: Dr. Chris Anderson, Department of Urology, St George’s Hospital, St George’s Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, United Kingdom. chris.anderson@stgeorges.nhs.uk
Telephone: +44-208-7253209 Fax: +44-208-7252915
Received: March 6, 2013
Revised: April 23, 2013
Accepted: May 7, 2013
Published online: July 24, 2013
Processing time: 140 Days and 13 Hours
Abstract

AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy (eRARP) vs transperitoneal robot-assisted radical prostatectomy (tRARP) in a single centre.

METHODS: A total of 120 consecutive patients underwent 50 eRARP and 70 eRARP operations respectively by the same surgical team. Peri-operative and post-operative outcomes including blood loss, hospitalization, complications (Clavien grade), positive surgical margin (PSM) rates, continence and erectile function were compared. The performance of eRARP required several technical modifications. These included development of Retzius’ space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; cranial digital stripping of peritoneum for sucker port and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.

RESULTS: Robotic console times were shorter with eRARP vs tRARP (145.1 min vs 198.3 min, P < 0.0001). There were no significant differences in blood loss, PSM rates (eRARP 17.7% vs tRARP 22%) or complications (eRARP 8.5% vs tRARP 8%). A drain was used in all patients after tRARP and in 25/70 eRARP cases. Length of hospital stay was shorter after eRARP (mean 1.94 d vs 3.6 d, P < 0.0002). There were no differences between techniques in continence or potency at 6 mo. eRARP required several technical modifications: development of Retzius’ space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.

CONCLUSION: eRARP demonstrated advantages in surgical times, hospital stay and equivalence in PSM rates, complications and functional outcomes. eRARP is a useful alternative to tRARP especially in patients with adhesions, pre-existing inguinal hernias, or those unable to withstand steep Trendelenburg position.

Keywords: Prostatic neoplasms; Robotics; Laparoscopy; Prostatectomy; Complications

Core tip: Extraperitoneal robot-assisted radical prostatectomy (RARP) is a feasible alternative to transperitoneal RARP with equivalent complication rates, and pathological and functional outcomes. This approach replicates the principles of open radical prostatectomy with minimal requirement for Trendelenberg position or post-operative drain. It is particularly suited for patients with adhesions, pre-existing inguinal herniae and those unable to stand robotic surgery in steep Trendelenburg position.