title: Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study.
abstract: OBJECTIVE
  To compare operative, pathological, and functional results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy carried out by a single surgeon.
  
  
  METHODS
  After having experience with 32 transperitoneal laparoscopic radical prostatectomies, 317 extraperitoneal laparoscopic radical prostatectomies, 30 transperitoneal robot-assisted laparoscopic radical prostatectomies and 10 extraperitoneal robot-assisted laparoscopic radical prostatectomies, 120 patients with prostate cancer were enrolled in this prospective randomized study and underwent either transperitoneal or extraperitoneal robot-assisted laparoscopic radical prostatectomy. The main outcome parameters between the two study groups were compared.
  
  
  RESULTS
  No significant difference was found for age, body mass index, preoperative prostate-specific antigen, clinical and pathological stage, Gleason score on biopsy and prostatectomy specimen, tumor volume, positive surgical margin, and lymph node status. Transperitoneal robot-assisted laparoscopic radical prostatectomy had shorter trocar insertion time (16.0 vs 25.9 min for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, P < 0.001), whereas extraperitoneal robot-assisted laparoscopic radical prostatectomy had shorter console time (101.5 vs 118.3 min, respectively, P < 0.001). Total operation time and total anesthesia time were found to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy, without statistical significance (200.9 vs 193.2 min; 221.8 vs 213.3 min, respectively). Estimated blood loss was found to be lower for extraperitoneal robot-assisted laparoscopic radical prostatectomy (P = 0.001). Catheterization and hospitalization times were observed to be shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (7.3 vs 5.8 days and 3.1 vs 2.3 days for transperitoneal robot-assisted laparoscopic radical prostatectomy and extraperitoneal robot-assisted laparoscopic radical prostatectomy, respectively, P < 0.05). The time to oral diet was significantly shorter in extraperitoneal robot-assisted laparoscopic radical prostatectomy (32.3 vs 20.1 h, P = 0.031). Functional outcomes (continence and erection) and complication rates were similar in both groups.
  
  
  CONCLUSIONS
  Extraperitoneal robot-assisted laparoscopic radical prostatectomy seems to be a good alternative to transperitoneal robot-assisted laparoscopic radical prostatectomy with similar operative, pathological and functional results. As the surgical field remains away from the bowel, postoperative return to normal diet and early discharge can be favored.
authors.affiliation: Department of Urology, School of Medicine, Selcuk University, Konya, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Akand
authors.affiliation: Departments of Urology and Minimally Invasive & Robotic Surgery, Memorial Atasehir Hospital, Istanbul, Turkey.
authors.forename: Tibet
authors.initials: T
authors.lastname: Erdogru
authors.affiliation: Departments of Urology and Minimally Invasive & Robotic Surgery, Memorial Atasehir Hospital, Istanbul, Turkey.
authors.forename: Egemen
authors.initials: E
authors.lastname: Avci
authors.affiliation: Department of Urology, Memorial Antalya Hospital, Antalya, Turkey.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Ates
mesh_terms: D000368:Aged; D000758:Anesthesia; D016063:Blood Loss, Surgical; D004435:Eating; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000209:etiology
keywords: extraperitoneal; prostate cancer; radical prostatectomy; robot-assisted laparoscopic radical prostatectomy; robotic surgery; transperitoneal