Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

Abstract

Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP) and with the extraperitoneal LRP (ELRP) during the learning curve (LC). Materials and Methods: Data of the initial 40 TLRP (Group 1) were retrospectively compared with the initial 40 ELRP (Group 2). Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001) and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001) were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5%) represented by one case of bleeding and one case of rectal injury, whereas four complications (10%) were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675). Open conversion occurred once in each Group (2.5%). Overall postoperative complications were similar (52.5% x 35%; p = 0.365). Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary), leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.Key words: prostate�� prostatic neoplasms�� prostatectomy�� laparoscopy prostate�� prostatic neoplasms�� prostatectomy�� laparoscopy Int Braz J Urol. 2010; 36: 450-7

Comparison of efficacy and safety of conventional laparoscopic radical prostatectomy by the transperitoneal versus extraperitoneal procedure

“…2 ). However, after excluding the results from Siqueira et al 17 , sensitivity analysis showed that there was a statistically significant difference between the TLRP and ELRP groups (MD: 30.75; 95% CI: 9.66–51.84; P = 0.004).…”

“…A total of 1715 patients were included in the 14 studies 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ; of these, 939 underwent TLRP and 776 underwent ELRP. All included studies reported on the number of patients.…”

“…Operation time was reported in eleven studies 9 10 11 13 14 15 16 17 18 19 20 (1159 patients): 617 receiving TLRP and 542 receiving ELRP. Heterogeneity was observed in the pooled analysis (P < 0.0001; I 2 = 95%).…”

Comments on the Extraperitoneal Approach for Standard Laparoscopic Radical Prostatectomy: What Is Gained and What Is Lost

“…Recently, Siqueira Jr. et al evaluating the complication of the two approaches during the learning curve (initial 40 cases for each approach), did not reveal any differences in overall complication rates. Yet complications encountered during the transperitoneal approach were judged as more serious due to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal approach [15]. …”

“…Extraperitoneal approach consists of accidental thermal injuries quite uncommon due to peritoneal sequestering of bowels outside the operating field. Moreover, bowel injuries, rarely occurring during trocar insertion and dorsal dissection of the overlying rectum prostatic apex, are considered a less severe complication in the extraperitoneal access than the transperitoneal approach, since the risk of generalized peritonitis is diminished [15]. Urinary bladder injury is mostly encountered during the initial dissection of the extraperitoneal space.…”