Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other?

To evaluate the differences, if any, in outcomes with transperitoneal (TP) versus extraperitoneal (EP) approaches during robotic-assisted radical prostatectomy (RARP).

We reviewed the data from 40 consecutive patients who underwent EP-RARP at our institution by the same surgical team. The outcomes were compared with those of 40 consecutive patients who underwent TP-RARP performed by the same team in a nonrandomized manner. The operative and postoperative parameters (total operative time, estimated blood loss, length of stay, robotic console time, and robotic anastomosis time), as well as complications and surgical margin status, were analyzed and compared.

The patient demographics were similar in both groups. Nerve sparing was performed in 35 and 36 patients in the TP and EP groups, respectively. Pelvic lymphadenectomy was performed in 14 and 12 patients in the TP and EP groups, respectively. The operative time was slightly longer with the TP approach at 236 minutes (range 111 to 360) compared with 229 minutes (range 143 to 382) in the EP group, but the difference was not statistically significant (P = 0.5722) between the two groups. Also, the differences in robot console time, anastomosis time, estimated blood loss, and length of stay were not statistically significant between the two groups at the 5% significance level. The complication and positive surgical margin rates were similar in both groups.

As expected, the EP approach is feasible with RARP. Our data suggest that the EP approach is comparable to the TP approach and produces favorable outcomes. Surgeon preference will likely play a significant role in the approach used.