Extraperitoneal v intraperitoneal robotic prostatectomy: analysis of operative outcomes.
OBJECTIVE
Robotic prostatectomy can be performed either via an extra- or intraperitoneal approach. The extraperitoneal approach has advantages similar to those of an extraperitoneal open radical prostatectomy, but the potential disadvantages of a small working space. We report our experience using both approaches.


METHODS
From July 2003 to June 2004, 55 patients underwent a robot-assisted laparoscopic prostatectomy. During the first 6 months, 21 prostatectomies were performed using an intraperitoneal approach (group 1); 34 were performed using an extraperitoneal approach (group 2) during the next 6 months. Clinicopathologic parameters and perioperative complications were compared in both groups. All patients were categorized as intent-to-treat analysis.


RESULTS
Median surgery time was significantly shorter in the extraperitoneal compared with the intraperitoneal approach (3 hours and 34 minutes v 4 hours and 1 minute, respectively, P = 0.017). This was because of the shorter time interval between the skin incision and incision of the endopelvic fascia in the extraperitoneal v the intraperitoneal approach (55 minutes v 74 minutes, respectively, P < 0.0001). There was no significant difference in terms of patient age, clinical and pathologic stage, length of hospital stay, and perioperative complications between the two approaches.


CONCLUSIONS
Extraperitoneal robot-assisted laparoscopic prostatectomy offers a similar clinical outcome as the intraperitoneal approach. However, the extraperitoneal approach avoids potential bowel injury or complications related to an intraperitoneal urine leak.
Madi
Rabii
R
Department of Urology, Michigan Urology Center, University of Michigan Medical School, Ann Arbor 48109-0330, USA.
Daignault
Stephanie
S
Wood
David P
DP
D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010537:Peritoneum; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome