Intraperitoneal effects of extraperitoneal laparoscopic radical prostatectomy.
OBJECTIVE
To compare routine radiologic and laboratory findings after extraperitoneal and transperitoneal laparoscopic radical prostatectomy (eLRP, tLRP) and assess relevant clinical correlations.


METHODS
Fifty consecutive eLRP and tLRP (laparoscopic and robot-assisted) were evaluated. Preoperative complete metabolic panel and complete blood count were determined, and these serum tests and amylase and lipase level measurements were repeated postoperatively. Ten consecutive eLRP and tLRP patients also underwent flat and upright abdominal x-rays. Operative time, perioperative complications, length of hospital stay, and amount of narcotic used were measured for each group.


RESULTS
On postoperative day 1, all eLRP patients evaluated (100%) had radiographic free air in the abdomen, as did 80% of the tLRP patients. Only 1 of 50 patients (2%) had elevated aspartate aminotransferase (eLRP), 2 of 50 (4%) had elevated alanine aminotransferase (both eLRP), and 4 of 50 (8%) had elevated amylase (3 eLRP, 1 tLRP). Postoperative narcotic usage (eLRP 25 +/- 3 mg versus tLRP 23 +/- 5 mg morphine equivalents) and operative times (eLRP 3.6 +/- 0.1 hours versus tLRP 3.8 +/- 0.1 hours) were similar between the groups. Length of hospital stay was lower in the eLRP compared with the tLRP group (1.9 +/- 0.1 days versus 2.2 +/- 0.1 days, P <0.05). Perioperative complications did not differ significantly between groups.


CONCLUSIONS
Extraperitoneal LRP and tLRP patients had comparable perioperative outcomes, and few had abnormal serum metabolic laboratory values postoperatively. Unexpectedly, abdominal free air was found in all eLRP patients evaluated radiographically on postoperative day 1, a finding that should be interpreted as normal and not specific for bowel injury in this context.
Bivalacqua
Trinity J
TJ
The Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA.
Schaeffer
Edward M
EM
Alphs
Hannah
H
Mettee
Lynda
L
Wagner
Andrew A
AA
Su
Li-Ming
LM
Pavlovich
Christian P
CP
D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood; D001772:Blood Cell Count; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D019990:Perioperative Care; D010537:Peritoneum / Q000000981:diagnostic imaging*; D011183:Postoperative Complications; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome
D009294:Narcotics; D008049:Lipase; D000681:Amylases