Extraperitoneal robot-assisted laparoscopic radical prostatectomy: Initial experience.
OBJECTIVE
To report our initial experience and technique of performing robot-assisted laparoscopic radical prostatectomy (RALP) with the extraperitoneal approach.


METHODS
Twenty-seven patients, between September 2010 to January 2012, were included in the study. All patients underwent extraperitoneal robot-assisted radical prostatectomy. Patients were placed supine with only 10-15(0) Trendelenburg tilt. The extraperitoneal space was developed behind the posterior rectus sheath. A five-port technique was used. After incision of endopelvic fascia and ligation of the deep venous complex, the rest of the procedure proceeded along the lines of the transperitoneal approach.


RESULTS
The mean patient age, prostate size and Gleason score were 67 ± 1.8 years, 45 ± 9.55 g and 6, respectively. The mean prostate-specific antigen (PSA) was 6.50 ng/mL. The mean time required for creating extraperitoneal space, docking of robot and console time were 22, 7 and 94 min, respectively. The mean time to resume full oral feeds was 22 ± 3.45 h. There were no conversions from extraperitoneal to transperitoneal or open surgery in our series. Pathological stage was pT1, pT2a and pT3b in 11 (40.74%), 14 (51.85%) and two (7.4%) patients, respectively. Two patients had positive surgical margins and two had biochemical recurrence at the last follow-up. Our mean follow-up was 12 ± 3.30 (2-17) months. The overall continence rate was 83.33% and 92.4% at 6 and 12 months, respectively.


CONCLUSIONS
Extraperitoneal RALP is an efficacious, minimally invasive approach for patients with localized carcinoma of the prostate.
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Prem Nath
PN
Dogra
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Ashish Kumar
AK
Saini
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Prabhjot
P
Singh
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Girdhar
G
Bora
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Brusabhanu
B
Nayak
Carcinoma prostate; extraperitoneal; prostatectomy; robotics