Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases

To compare the results of 122 transperitoneal laparoscopic radical prostatectomy (TP-LRP) procedures with those of 34 extraperitoneal LRP (EP-LRP) procedures to assess for differences in outcomes and complications. Both TP-LRP and EP-LRP have been touted as effective techniques for performing LRP.

We retrospectively reviewed 156 LRPs performed by a single surgeon (D.M.D.) at a single institution between October 2001 and June 2003. EP-LRP was introduced in February 2003.

The cohorts were similar in terms of mean patient age, height, weight, body mass index, and American Society of Anesthesiologists Physical Status Classification. Of the total cohort, 19 TP-LRP (16%) and 11 EP-LRP (32%) patients had clinical Stage T2; the remainder had clinical Stage T1c. Similarly, 18 TP-LRP (15%) and 9 EP-LRP (26%) patients had a biopsy Gleason grade of 7 or greater. About one third of patients underwent concomitant pelvic lymphadenectomy (all negative), and 15 TP-LRP (12%) and 2 EP-LRP (6%) patients underwent simultaneous inguinal or umbilical herniorrhaphy. Six TP-LRP patients (5%) required significant lysis of bowel adhesions. The patients in both groups had similar mean operative times (197 minutes and 191 minutes for the TP-LRP and EP-LRP group, respectively; P = 0.29). Clinically significant anastomotic leaks were documented in 7 (6%) TP-LRP and 4 (12%) EP-LRP patients (P = 0.22). The two groups had similar mean hemoglobin decreases (3.0 g/dL) and transfusion rates. The mean time of drainage and hospitalization was 0.5 day longer for the TP-LRP cohort. A mean pathologic Gleason grade of 6.3 was noted for each cohort. Twenty-one TP-LRP (17%) and eight EP-LRP (24%) specimens were pathologic Stage T3, and 29 (24%) of the former and 7 (21%) of the latter (P = 0.81) specimens were margin positive. The complication rates were similar (11% and 12% in TP-LRP and EP-LRP groups, respectively; P = 1.0), except for a greater rate of ileus in the TP-LRP cohort (3 patients).

Extraperitoneal LRP appears to offer similar results to TP-LRP. TP-LRP was associated with a slightly greater ileus rate and EP-LRP with a slightly greater anastomotic leak rate (P = 0.22). However, the latter may have been the result of improved detection. Also, it was easier to manage using the EP-LRP approach.