Robotic Prostatectomy: Does the Approach matter?

Abstract

Introduction: Robotic Assisted Laparoscopic Radical Prostatectomy has become more popular among patients with early prostate cancer. Surgeons can choose either transperitoneal approach or extraperitoneal approach for the access to the prostate gland. Transperitoneal route can provide more working space during the procedure, but, at the expense of, more risk of bowel injuries, longer post- operative ileus, intra-abdominal collection, and increased risk of intra-abdominal adhesion in long term. Extraperitoneal Robotic Prostatectomy mimics open Radical Prostatectomy, avoiding all potential intra- abdominal complications. This study compares early results of Robotic Assisted Laparoscopic Radical Prostatectomy in the two approaches.

Material and Method: Robotic Assisted Laparoscopic Radical Prostatectomy was carried out by the author in 72 patients with early prostate cancer. The patients were divided into 2 groups (36 patients each) of Transperitoneal Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP) and Extraperitoneal Robotic Assisted Laparoscopic Radical Prostatectomy (ERALRP). Peri-operative data of the two groups were compared using T-Test and Chi-Square Test. All important findings were reported here.

Results: All 72 patients were successfully undergone Robotic Assisted Laparoscopic Radical Pros- tatectomy. The mean operative time was significantly shortened in the ERALRP group (p<0.05). The ERALRP group has also shown less intra-operative blood loss than blood loss in the RALRP group. However, longer urethral catheterization time was found in ERALRP patients.

Conclusion: Extraperitoneal Robotic Assisted Laparoscopic Radical Prostatectomy is safe and feasible. The approach can be used as an alternative choice of surgery heading toward more minimally invasive procedure, giving less risk of intra-abdominal complications.