title: Randomized comparison of extraperitoneal and transperitoneal access for robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, University of Rochester, Rochester, New York 14642, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Capello
authors.forename: Judd
authors.initials: J
authors.lastname: Boczko
authors.forename: Hitendra R H
authors.initials: HR
authors.lastname: Patel
authors.forename: Jean V
authors.initials: JV
authors.lastname: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome