Extraperitoneal lap, robotic RP show excellent outcomes in retrospective review

Use of an extraperitoneal approach for either laparoscopic or robot-assisted radical prostatectomy yields excellent results and has a number of significant advantages over a transperitoneal route, say surgeons who presented their experience with extraperitoneal surgery at the AUA annual meeting here.

Data were analyzed retrospectively from a two-center study that included 754 patients who underwent robot-assisted prostatectomy at the University of Rochester (New York) Medical Center and 800 patients who underwent laparoscopic RP at the Henri Mondor Hospital, Creteil, France. At both centers, men with a PSA of 10.0 ng/mL or higher and/or a Gleason score of 7 or higher also underwent lymph node dissection.

Total operative time was 194 minutes for the robotic approach and 179 minutes for the laparoscopic approach. Mean estimated blood loss and transfusion rate were 190 mL and 1.3%, respectively, for robotic RP and 768 mL and 4.3%, respectively, for laparoscopic RP.

Surgical complications occurred in about 7% of men undergoing the robotic approach, and urinary retention and urine leak each occurred at rates of 1.6%. The surgical complication rate was 2.3% in the laparoscopic series; 6% of men developed urinary retention and a urine leak was identified at cystogram in 14% of men. Mean catheter time in the laparoscopic and robotic groups was 6.1 and 10.2 days, respectively.

The difference reflects the fact that the French patients generally recover in the hospital and have their catheters removed prior to discharge, whereas the U.S. patients generally went home after 1 day and had the catheter removed when they returned to the office the following week.

"Laparoscopic and robot-assisted radical prostatectomy are products of our quest for less-invasive alternatives to open surgery, but ultimately our goal with these procedures has been to simulate the open technique. The extraperitoneal approach does that best, and, compared to transperitoneal surgery, it has advantages that enable faster recovery and fewer complications over the longer term," said first author Jean V. Joseph, MD, MBA, of the University of Rochester.

"However, the best approach for any surgeon performing radical prostatectomy remains the one where he or she can achieve cancer control while preserving continence and potency."