Back to Program


Extraperitoneal Versus Transperitoneal Approach to Robotic Assisted Radical Prostatectomy: Comparative Analysis of Surgical Technique and Operative Outcomes-Single Institution Experience
Satya Allaparthi, MRCS, MD, Thomas Hoang, MD, Nadeem N. Dhanani, MD, MPH Ingolf A. Tuerk, MD, PhD.
Caritas St Elizabeth Hospital, Boston, MA, USA.

Background
To compare the surgical technique and operative outcomes of the two main variants of robotic assisted radical prostatectomy(RARP): the more often used transperitoneal approach (TP-RARP) and a purely extraperitoneal approach (EP-RARP).
Methods.
After the Institutional Review Board approval, a retrospective chart review was performed. We reviewed the 352 charts of all the patients who had undergone EP-RARP and TP-RARP done by single surgeon (IT) at our institution in between November 2008 and February 2010. In this analysis, we assessed and compared variables that included patient age, body mass index, prostate specific antigen, pathological stage, margin status, operative time, blood loss, length of stay and rehospitalization rate. Statistical analysis was done using SYSTAT®13 statistical package. Comparative analysis was done using the Student t-test, with P < 0.05 considered statistically significant for normally distributed continuous data and Chi-square and Fisher’s exact tests were used to compare categorical outcome variables.
Results.
Of the 352 patients, 301 had EP-RARP and 51 TP-RARP. The mean ± SD of age (years), prostate weight (gms) and PSA(ng/ml) in EP and TP groups were 59.5±7.04 vs. 59.7±7.5 ;(p=0.84); 48.75±16.08 vs.51.98±18.7 (p=0.19) and 5.6±3.8 vs. 6.8±6.7 (p=0.081) respectively. However, a statistically significant difference was noted in BMI (kg/m²) 27.4± 3.3 and 33.6± 4.87 (p<0.001) between two groups. There were no statistically significant differences in operative time (minutes)127.2± 20.06 vs.132.3±25.09 (p= 0.103), and length of stay(days) 1.11 ± 0.87 vs.1.039 ± 0.196 (p=0.54). We noticed that, patients in EP group had significantly higher blood loss compared with the TP group with an EBL in ml 212.74±147.05 vs. 144.5±93.7.(p<0.001).Pelvic lymph node dissection (PLND ) was done in both groups in 42.5% and 8.6% (p=0.419) of patients respectively. Pathological staging distribution in both groups were T2c 53.3% vs. 65.45% and T3a 24.6% vs. 17.4% respectively. In both groups, surgical positive margin rates in T2c and T3a were 12.95% vs. 10.8% and 12.6% vs. 13.7% respectively. Based on Clavein -Dindo Classification of surgical complications system, there were 6 grade I, 6 grade II, 4 grade III a ,6 grade III b and 2 grade IV a complication in EP-RARP group and 2 gradeI,1 grade II, 1 grade III a and 1 grade III b complications in TP-RARP group respectively. In our series, we noticed 13 lymphoceles in EP and 1 in TP group respectively. There were no DVTs in EP group however; we noticed one in the TP. There was no significant difference in hospital readmission rates between the groups.
Conclusion
In our series, the data suggests that EP approach appears to offer similar results to that of TP and produce favorable clinical outcomes. However, EP approach is attractive in patients with co-morbidities where positioning compromises ventilation and with prior abdominal surgeries. Surgeon’s preference and patient characteristics are likely to play a significant role in the approach used.


Back to Program