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Updated: Jul 12, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A
Stefanus Purnomo1, Agus Rizal Ardy Hariandy Hamid1, Moammar Andar Roemare Siregar2
1Department of Urology, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Jakarta, Indonesia.
Extraperitoneal radical prostatectomy (EP-RP) offers a lower risk of operative complications compared to transperitoneal radical prostatectomy (TP-RP). This minimally invasive surgery approach showed no significant differences in other key outcomes like operative duration or blood loss.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Radical prostatectomy is a primary treatment for localized prostate cancer.
- Transperitoneal radical prostatectomy (TP-RP) and extraperitoneal radical prostatectomy (EP-RP) are established minimally invasive surgical approaches.
- Comparative outcome data between TP-RP and EP-RP are crucial for surgical decision-making.
Purpose of the Study:
- To compare the outcomes of transperitoneal radical prostatectomy (TP-RP) versus extraperitoneal radical prostatectomy (EP-RP) in minimally invasive surgery.
- To analyze operative duration, estimated blood loss (EBL), hospital stay, operative complications, and positive surgical margins.
- To evaluate differences within laparoscopy radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) subgroups.
Main Methods:
- A systematic literature search was conducted across PubMed, Cochrane, Scopus, EMBASE, and Science Direct up to September 2022.
- Included 13 studies comprising 2387 patients undergoing either TP-RP or EP-RP.
- Analyzed outcomes including operative duration, EBL, hospital stay, operative complications, and positive surgical margins.
Main Results:
- Extraperitoneal radical prostatectomy (EP-RP) demonstrated a significant advantage in reducing operative complications (RR=0.78, P=.04) compared to TP-RP.
- No significant differences were observed between EP-RP and TP-RP for operative duration, EBL, hospital stay, or surgical margins.
- In robot-assisted radical prostatectomy (RARP), EP-RARP showed significant benefits in operative duration (MD=-17.27, P=.0004) and hospital stay (MD=-0.54, P=.008) compared to TP-RARP.
Conclusions:
- Extraperitoneal radical prostatectomy (EP-RP) is associated with a lower risk of operative complications than transperitoneal radical prostatectomy (TP-RP).
- The choice between EP-RP and TP-RP does not significantly impact operative duration, estimated blood loss, hospital stay, or surgical margin status.
- These findings support EP-RP as a potentially safer approach regarding operative complications in minimally invasive radical prostatectomy.
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