Adult urologyTransperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: Is one better than the other?
Section snippets
Material and methods
The initial 100 cases of RARP performed at our institution used the TP approach. Once we were comfortable with the robotic technique, 40 patients subsequently underwent RARP using the EP approach. No specific method was used to choose the EP versus TP approach, except for surgeon preference. All patients underwent standard preoperative clinical staging with digital rectal examination, prostate-specific antigen measurement, and Gleason score determination. Our institutional review board approved
Results
The patient demographics are listed in Table I. The demographics were similar in the two groups. Pelvic lymphadenectomy was performed in 14 and 12 patients in the TP and EP groups, respectively. Nerve sparing was performed in 35 and 36 patients in the TP and EP groups, respectively. The body mass index was also comparable in both groups (27.4 kg/m2 for the TP group and 27.8 kg/m2 for the EP group).
Comment
LRP is a minimally invasive treatment option that often requires a great deal of laparoscopic suturing expertise. The application of robotic technology to LRP is a relatively recent addition to the urologist’s armamentarium. The robotic systems provide the advantages of three-dimensional vision, magnification, and a robotic wrist. It is these advantages that have allowed for the recent increased use of RARP for prostate cancer.
The feasibility and applicability of RARP has been reported using a
Conclusions
The results of this study have shown that the EP approach is feasible using RARP, with results comparable to those using the TP approach. According to the present results, the two approaches have individual operative advantages and disadvantages. However, the overall outcomes are similar, and surgeon preference will likely play a role in deciding which approach is used.
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F. Atug is supported by Tubitak (the Scientific and Technological Research Council of Turkey). R. Thomas is a paid consultant to Olympus, is a member of the speaker’s bureau for Boehringer Ingelheim, and is a proctor for Intuitive Surgical.