Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: which one?

Area of Science:

• Urology
• Surgical Technology
• Robotics in Medicine

Background:

• Robotic radical prostatectomy is increasingly popular, yet challenges like training and surgical outcomes persist.
• Two primary surgical approaches exist: trans-peritoneal (TP) and extraperitoneal (EP).
• The TP approach is more widely adopted than the EP approach.

Purpose of the Study:

• To discuss the unresolved issues in robotic radical prostatectomy.
• To compare the trans-peritoneal (TP) and extraperitoneal (EP) approaches.
• To highlight indications and challenges of the EP approach.

Main Methods:

• Review of common topics in robotic prostatectomy forums.
• Comparison of TP and EP approaches for robotic radical prostatectomy.
• Discussion of patient selection and surgical considerations for each approach.

Main Results:

• The TP approach is generally recommended for surgeons beginning their robotic surgery learning curve.
• The EP approach offers significant benefits for specific patient populations, including the obese or those with prior abdominal surgeries or ostomies.
• While the EP approach presents challenges such as limited space for robotic instruments and potentially for pelvic lymph node dissection, these can be overcome in experienced hands.

Conclusions:

• The TP approach is currently the predominant method for robotic radical prostatectomy.
• Familiarity with the EP approach is crucial for surgeons to address specific patient needs and indications.
• Mastering the TP approach first can facilitate the learning curve before adopting the EP approach.