title: Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy: experience of a single center.
abstract: OBJECTIVE
  To analyze, in a consecutive study, the perioperative, postoperative, and functional results of the transperitoneal and extraperitoneal approaches for laparoscopic radical prostatectomy.
  
  
  METHODS
  A total of 160 patients underwent radical prostatectomy and were subdivided into two groups. Group 1 underwent the transperitoneal approach and group 2, the extraperitoneal approach. The preoperative parameters, age, prostate-specific antigen level, biopsy Gleason score, American Society of Anesthesiologists class, body mass index, and clinical stage, were considered. The perioperative parameters evaluated were the operative time, blood loss, blood transfusion, hospital stay, catheterization time, complications, histopathologic findings, TNM stage, Gleason score, prostate and tumor volumes, and functional results.
  
  
  RESULTS
  The patients in both groups had comparable preoperative data. No differences were observed between the two groups in the intraoperative data, except for the mean operative time (179 +/- 54.6 for group 1 versus 133.7 +/- 27 minutes for group 2). Also, no differences were observed between the two groups in terms of the postoperative data. The proportion of complications was 21.25% in group 1 and 22.5% in group 2. We recorded symptomatic lymphocele requiring treatment with a drain or reoperation in 8 patients (10%) in group 2 and 0% in group 1 (P <0.001) of all the patients who underwent lymphadenectomy. The rate of positive surgical margins was 25% for group 1 and 21.25% for group 2 (P = NS). For those with Stage pT2, the positive margin rate was 7.3% and 10% for groups 1 and 2, respectively. The recovery of continence at 3 months was faster in group 2 (75% of patients versus 50.9% in group 1; P <0.01).
  
  
  CONCLUSIONS
  The extraperitoneal approach required less operative time and enabled faster recovery of continence and the transperitoneal approach prevented the formation of lymphocele.
authors.affiliation: Department of Urology, University of Turin, San Luigi Hospital, Orbassano, Torino, Italy. porpiglia@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.forename: Roberto
authors.initials: R
authors.lastname: Tarabuzzi
authors.forename: Michele
authors.initials: M
authors.lastname: Billia
authors.forename: Susanna
authors.initials: S
authors.lastname: Grande
authors.forename: Francesca
authors.initials: F
authors.lastname: Musso
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Burruni
authors.forename: Julien
authors.initials: J
authors.lastname: Renard
authors.forename: Roberto Mario
authors.initials: RM
authors.lastname: Scarpa
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*