title: Extraperitoneal robot-assisted laparoscopic radical prostatectomy: a single-center experience beyond the learning curve.
abstract: OBJECTIVE
  To report our surgical technique and outcomes after extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALRP).
  
  
  METHODS
  At Henri Mondor's Hospital, we performed the first RALRP in 2001 and started to perform routinely RALRP since 2006. Preoperative characteristics, perioperative parameters, functional and oncological outcomes were collected in a prospective database and studied. All parameters were tested in patients undergoing RALRP beyond the learning curve of each surgeon. The overall cohort included 792 patients.
  
  
  RESULTS
  RALRP offers interesting results in terms of hospital stay, operative time, and blood loss. The overall rate of complications was low, especially concerning the rates of anastomosis' complications. An extraprostatic extension was seen in 42.8 % of specimens. The overall rate of positive margins was 30.7 % of specimens. In our cohort, after a mean follow-up of 19 months, 8.7 % of PSA failure has been reported. The rate of continence was 77.4 % at 6 months and 96.8 % at 2 years. The rate of potency was 17 % at 3 months and 60.9 % at 2 years. The 2-year rate was 86.7 % in case of intrafascial dissection. A trifecta outcome was achieved in 44 and 53 % of men at 12 and 24 months, respectively.
  
  
  CONCLUSIONS
  The extraperitoneal approach confers interesting results in terms of perioperative parameters as previously described in series using a transperitoneal approach. Functional outcomes in terms of continence and potency recovery after extraperitoneal seem equivalent to those reported after transperitoneal RALRP. Longer follow-up is warranted to confirm our favorable mid-term oncologic outcomes.
authors.affiliation: Department of Urology, Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. g.ploussard@gmail.com
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Bastien
authors.initials: B
authors.lastname: Parier
authors.forename: Claude Clément
authors.initials: CC
authors.lastname: Abbou
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
mesh_terms: D016063:Blood Loss, Surgical; D015331:Cohort Studies; D007172:Erectile Dysfunction / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology