Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: A prospective single...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted laparoscopic radical prostatectomy (RALRP) is a standard treatment for prostate cancer.
• Both transperitoneal and extraperitoneal approaches exist for RALRP, each with potential advantages.
• Comparative data on operative, pathological, and functional outcomes between these two RALRP approaches are valuable for surgical decision-making.

Purpose of the Study:

• To compare the operative, pathological, and functional outcomes of transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALRP).
• To evaluate recovery parameters such as catheterization, hospitalization, and return to oral diet.
• To assess complication rates and functional results (continence and erection) between the two surgical approaches.

Main Methods:

• A prospective randomized study involving 120 patients with prostate cancer undergoing RALRP.
• Patients were randomized to either transperitoneal RALRP or extraperitoneal RALRP, performed by a single surgeon.
• Key outcomes including operative time, blood loss, pathological results, functional recovery, and complications were compared.

Main Results:

• No significant differences were observed in pathological outcomes (stage, Gleason score, margins, lymph nodes) between the groups.
• Extraperitoneal RALRP demonstrated significantly lower estimated blood loss and shorter catheterization and hospitalization times.
• While trocar insertion time was shorter for transperitoneal, console time was shorter for extraperitoneal; the latter also showed a faster return to oral diet.

Conclusions:

• Extraperitoneal robot-assisted laparoscopic radical prostatectomy is a viable alternative to the transperitoneal approach, yielding comparable oncological and functional results.
• The extraperitoneal approach may facilitate enhanced postoperative recovery, potentially due to maintaining the surgical field separate from the bowel.
• Benefits include a quicker return to a normal diet and earlier hospital discharge, suggesting improved patient recovery trajectories.