Robotic extraperitoneal radical prostatectomy: an alternative approach.

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robot-assisted laparoscopic radical prostatectomy is increasingly common.
• The transperitoneal approach is the predominant method used worldwide.
• Alternative surgical approaches are being explored to optimize outcomes.

Purpose of the Study:

• To report the experience and outcomes of robot-assisted extraperitoneal laparoscopic radical prostatectomy.
• To evaluate the feasibility and safety of this novel surgical technique.
• To compare results with existing literature on prostatectomy.

Main Methods:

• A total of 325 patients with clinically localized prostate cancer underwent the procedure over two years.
• Perioperative, oncological, and functional data were prospectively collected.
• The extraperitoneal approach was utilized with da Vinci robotic assistance.

Main Results:

• The average operative time was 130 minutes with a mean blood loss of 196 cc.
• No intraoperative conversions to open surgery were required.
• Pathological stages ranged from pT2a to pT3b, with a 13% positive surgical margin rate and 2.1% positive nodal disease.

Conclusions:

• The extraperitoneal approach enhances robotic dexterity and visualization while avoiding peritoneal cavity complications.
• This technique simulates open retropubic prostatectomy, offering potential advantages.
• The extraperitoneal approach is likely to increase in popularity as surgical experience grows.