Yong Seung Lee; Won Sik Ham; Won Tae Kim; Hui Jung Joo; Jin Sun Lee; Young Deuk Choi

doi:10.4111/kju.2009.50.3.251

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Lee, Ham, Kim, Joo, Lee, and Choi: Comparison of Extraperitoneal and Transperitoneal Robot-Assisted Radical Prostatectomy in Prostate Cancer: A Single Surgeon’s Experience

Original Article

Korean J Urol 2009;50(3):251-255.

Published online: 19 March 2009

DOI: https://doi.org/10.4111/kju.2009.50.3.251

Comparison of Extraperitoneal and Transperitoneal Robot-Assisted Radical Prostatectomy in Prostate Cancer: A Single Surgeon’s Experience

Yong Seung Lee, Won Sik Ham, Won Tae Kim, Hui Jung Joo, Jin Sun Lee, Young Deuk Choi

From the Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Young Deuk Choi Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 250, Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea TEL: 02-2228-2317 FAX: 02-312-2538 E-mail: youngd74@yuhs.ac

Received 17 December 2008 Accepted 11 January 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the feasibility and safety of the extraperitoneal robotic radical prostatectomy (ERP), we compared the results of transperitoneal robotic radical prostatectomy (TRP) with those of ERP performed by a single surgeon.

Materials and Methods

All operation was performed by a single surgeon, who had the experience of more than 150 transperitoneal cases. Recently, 30 cases were performed through transperitoneal approach, and then extraperitoneal approach was applied to next 30 cases. We compared the clinicopathologic parameters and perioperative outcomes between two groups.

Results

There were no significant differences in mean age, body mass index (BMI), preoperative prostate-specific antigen (PSA) level, prostatectomy Gleason scores and pathologic T stage between two groups, whereas positive surgical margin rate was significantly lower in ERP. There was no significant difference in total operation time, whereas console time, and vesicourethral anastomosis time significantly decreased in ERP. There were no significant differences in postoperative normal diet start day, the duration of hospital stay and bladder catheterization. There were no significant differences in the amount of estimated blood loss and the number of resected lymph nodes. In both groups, there were no inadvertent organ injury during trocar placement and conversion to open surgery, whereas 1 case of lymphocele in ERP was recovered with conservative care.

Conclusions

ERP showed similar perioperative outcomes compared to TRP. Considering the potential risk of bowel injury in TRP and reduced peritoneal irritation in ERP, ERP may be alternative in robotic radical prostatectomy.

Keywords: Prostatic neoplasms, Prostatectomy, Laparoscopy, Robotics

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Fig. 1.

The position of port placement in extraperitoneal robotic radical prostatectomy.

Table 1.

Comparison of clinicopathologic results of RP between the transperitoneal (TRP) and extraperitoneal (ERP) approaches

Variables	TRP (n=30)	ERP (n=30)	p-value
Mean age (years)	66.9±8.0	65.3±7.9	0.428^a
BMI (kg/m²)	23.7±2.4	24.1±2.1	0.206^a
Preoperative PSA (ng/ml)	15.5±15.4	17.7±27.6	0.451^a
RP Gleason score (%)			0.522^b
≤6	7 (23.3)	10 (33.3)
7	13 (43.3)	9 (30.0)
≥8	10 (33.3)	11 (36.7)
Pathologic T stage (%)			0.684^b
T2	9 (30.0)	11 (36.7)
T3	20 (66.7)	17 (56.7)
T4	1 (3.3)	2 (6.7)
Positive surgical margins (%)	19 (63.3)	10 (33.3)	0.038^c

TRP: transperitoneal robotic radical prostatectomy, ERP: extraperitoneal robotic radical prostatectomy, BMI: body mass index, PSA:

^a : Student’s prostate-specific antigen, RP: radical prostatectomy. t-test,

^b : Fisher’s exact test,

^c : chi-square test

Table 2.

Comparison of perioperative results of RP between the transperitoneal (TRP) and extraperitoneal (ERP) approaches

Variables	TRP (n=30)	ERP (n=30)	p-value
Mean operative time (min.)	202.1±31.5	206.2±25.7	0.520^a
Mean robot consol time (min.)	121.8±19.7	106.4±19.8	0.003^a
Mean anastomosis time (min.)	20.4±6.6	15.8±3.6	0.001^a
Mean length until normal diet (days)	1.0±0.0	1.0±0.0	1.000^a
Mean length of hospital stay (days)	6.2±1.7	6.6±2.9	0.958^a
Mean length of bladder catheterization (days)	7.3±0.6	7.7±1.2	0.076^a
Mean blood loss (ml)	361.7±150.1	445.0±165.2	0.060^a
Mean number of dissected LN	12.1±10.7	11.6±8.2	0.994^a
10 cm visual analog scale
POD #1	5.5±0.5	2.8±0.4	＜0.001^a
POD #2	5.0±0.7	2.4±0.5	＜0.001^a
POD #3	2.3±0.5	1.3±0.5	0.089^a

TRP: transperitoneal robotic radical prostatectomy, ERP: extraperitoneal robotic radical prostatectomy, LN: lymph node, POD: post operative day.

^a : Student’s t-test

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