title: Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system.
abstract: OBJECTIVE
  We developed and assessed the feasibility of extraperitoneal laparoscopic radical prostatectomy performed using the da Vinci (Intuitive Surgical, Mountain View, California) robotic system.
  
  
  METHODS
  In June 2002, 4 consecutive patients with clinically localized prostate cancer underwent extraperitoneal, robotic assisted laparoscopic radical prostatectomy. After development of the extraperitoneal space the surgeon performed laparoscopic prostatectomy from the remote control unit. The assistant aligned and exchanged robotic instruments and used conventional laparoscopic instruments to facilitate prostatectomy. Perioperative data and pathological results were recorded.
  
  
  RESULTS
  No difficulties were noted when developing the extraperitoneal space. All additional steps were successfully performed with telerobotics. More distal placement of the robotic ports appeared to improve the feasibility of the extraperitoneal approach. The peritoneum acted as a natural bowel retractor and the distal port placement facilitated use of the assistant ports. Mean operative time was 274 minutes (range 124 to 360). Mean catheterization time and hospital stay were 2.7 and 5.3 days, respectively. A positive margin was observed in 1 patient and pathological stage was pT2 in 3 and pT3 in 1. No postoperative complications or open conversions were observed.
  
  
  CONCLUSIONS
  The extraperitoneal approach was feasible with the da Vinci robotic system. Distal port placement for the robot appeared to create an ergonomic environment for the surgeon and assistant and more direct prostatic access. While additional clinical experience is required, the extraperitoneal approach may ultimately provide advantages for robotic and nonrobotic laparoscopic radical prostatectomy.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: András
authors.initials: A
authors.lastname: Hoznek
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Borkowski
authors.forename: Patrick
authors.initials: P
authors.lastname: Antiphon
authors.forename: Adrian
authors.initials: A
authors.lastname: Lobontiu
authors.forename: Clément-Claude
authors.initials: CC
authors.lastname: Abbou
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics