title: Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?
abstract: OBJECTIVE
  To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP) and with the extraperitoneal LRP (ELRP) during the learning curve (LC).
  
  
  METHODS
  Data of the initial 40 TLRP (Group 1) were retrospectively compared with the initial 40 ELRP (Group 2). Each Group of patients was operated by two different surgeons.
  
  
  RESULTS
  The overall surgical time (175 min x 267.6 min; p < 0.001) and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001) were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5%) represented by one case of bleeding and one case of rectal injury, whereas four complications (10%) were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675). Open conversion occurred once in each Group (2.5%). Overall postoperative complications were similar (52.5% x 35%; p = 0.365). Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary), leading to one death in this group.
  
  
  CONCLUSIONS
  No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.
authors.affiliation: Section of Urology, Getulio Vargas Hospital, Recife, Pernambuco, Brazil. tiberiojr@uol.com.br
authors.forename: Tiberio M
authors.initials: TM
authors.lastname: Siqueira
authors.forename: Anuar I
authors.initials: AI
authors.lastname: Mitre
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Duarte
authors.forename: Humberto
authors.initials: H
authors.lastname: Nascimento
authors.forename: Francualdo
authors.initials: F
authors.lastname: Barreto
authors.forename: Evandro
authors.initials: E
authors.lastname: Falcao
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Lopes
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000368:Aged; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education*; D059032:Learning Curve; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000193:education*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies