Transperitoneal or Extraperitoneal Laparoscopic Radical Prostatectomy: Does the Approach Matter?

Eden, Christopher; King, Derek J.; Kooiman, G.; Adams, Tom; Sullivan, M. X.; Vass, Justin

doi:10.1097/01.ju.0000144640.26182.41

Cited by 84 publications

(57 citation statements)

References 16 publications

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“…However, Eden et al reported that urinary continence happened earlier with the extraperitoneal approach due to larger dissection and consequent bladder denervation that occurs in the transperitoneal approach (23). In relation to sexual potency, results were quite satisfactory, which can be explained by the clear identification of the pedicle and the use of clip in the prostate pedicles, thus preventing the heat to be transmitted to the neurovascular bundle.…”

Section: Commentsmentioning

confidence: 86%

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Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

Tobias-Machado¹,

Lasmar²,

Medina³

et al. 2005

Int. braz j urol.

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Objective: To describe surgical and functional results with extraperitoneal laparoscopic radical prostatectomy with duplication of the open technique, from the experience obtained in the treatment of 28 initial cases.Materials and Methods: In a 36-month period, we prospectively analyzed 28 patients diagnosed with localized prostate cancer undergoing extraperitoneal laparoscopic radical prostatectomy.Results: Mean surgical time was 280 min, with mean blood loss of 320 mL. As intraoperative complications, there were 2 rectal lesions repaired with laparoscopic suture in 2 planes. There was no conversion to open surgery. Median hospital stay was 3 days, with return to oral diet in the first postoperative day in patients. As post-operative complications, there were 3 cases of extraperitoneal urinary fistula. Two of these cases were resolved by maintaining a Foley catheter for 21 days, and the other one by late endoscopic reintervention for repositioning the catheter. Five out of 18 previously potent patients evolved with erectile dysfunction. The diagnosis of prostate cancer was confirmed in all patients, with focal positive margin occurring in 3 cases. During a mean follow-up of 18 months, 2 patients presented increased PSA, with no clinical evidence of disease.Conclusion: Laparoscopic radical prostatectomy is a laborious and difficult procedure, with a long learning curve. Extraperitoneal access is feasible, and it is possible to practically duplicate the principles of open surgery. The present technique can possibly offer advantages in terms of decreased blood loss, preservation of erectile function and prevention of positive margins.

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Section: Commentsmentioning

confidence: 86%

“…Mean age was 66 years (55-73), with mean body mass index of 24 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Twenty-five (89.3%) had ASA surgical risk II and 3 patients were ASA I (10.7%).…”

Section: Between February 2001 and February 2004mentioning

confidence: 99%

Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

Tobias-Machado¹,

Lasmar²,

Medina³

et al. 2005

Int. braz j urol.

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“…Some authors prefer the transperitoneal approach based on the larger working space and better luminosity and others prefer the extraperitoneal counterpart, based on the lack of contact with the intraperitoneal organs (3)(4)(5)(6).…”

Section: Clinical Urology Doi: 101590/s1677-55382010000400008mentioning

confidence: 99%

Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

et al. 2010

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Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP) and with the extraperitoneal LRP (ELRP) during the learning curve (LC). Materials and Methods: Data of the initial 40 TLRP (Group 1) were retrospectively compared with the initial 40 ELRP (Group 2). Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001) and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001) were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5%) represented by one case of bleeding and one case of rectal injury, whereas four complications (10%) were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675). Open conversion occurred once in each Group (2.5%). Overall postoperative complications were similar (52.5% x 35%; p = 0.365). Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary), leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.Key words: prostate�� prostatic neoplasms�� prostatectomy�� laparoscopy prostate�� prostatic neoplasms�� prostatectomy�� laparoscopy Int Braz J Urol. 2010; 36: 450-7

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“…8,[55][56][57][58][59][60][76][77][78][79][80] Table 1 shows urinary continence rates for RRP and LRP, defined as no need for any pads or "protection." Table 2 shows the sexual potency rates.…”

Section: Urinary and Sexual Functionmentioning

confidence: 99%

Management of Complications of Prostate Cancer Treatment

Michaelson

Cotter

Gargollo

et al. 2008

CA: A Cancer Journal for Clinicians

162

146

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Transperitoneal or Extraperitoneal Laparoscopic Radical Prostatectomy: Does the Approach Matter?

Abstract: : ELRP is superior to TLRP with respect to operative time, hospitalization and early continence.

Cited by 84 publications

References 16 publications

Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

Management of Complications of Prostate Cancer Treatment

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