Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy

Hoznek, A.; Antiphon, Patrick; Borkowski, Tomasz; Gettman, Matthew T.; Katz, Ran; Salomon, Laurent; Zaki, Safwat; Taille, Alexandre de la; Abbou, Clément-Claude

doi:10.1016/s0090-4295(02)02415-9

Cited by 127 publications

(66 citation statements)

References 15 publications

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“…Our first 22 patients were operated using the transperitoneal approach, with an average operating time of 297 min, compared to our previously published time of 224 min [1,7] . Difficult dissection was encountered in 14/22 patients without a specific site of difficulty.…”

Section: Discussionmentioning

confidence: 92%

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Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

Katz

Borkowski²,

Hoznek³

et al. 2006

Urol Int

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Objectives: Previous transurethral resection of the prostate (TURP) was reported to impose difficulties during open radical prostatectomy. We describe our experience in laparoscopic radical prostatectomy (LRP) following transurethral resection of the prostate. Patients and Methods: The series included 35 patients: 22 patients underwent transperitoneal LRP (tpLRP) and 13 underwent extraperitoneal LRP (epLRP). The minimal interval between TURP and laparoscopy was 3 months. Patients’ charts were reviewed for their preoperative characteristics, intraoperative difficulties and complications, and outcome. Results: Patients’ mean age was 67.5 ± 4.4 years. 12 patients were cT1a,b and 23 patients were cT1c/T2. Twenty-two patients underwent tpLRP and 13 underwent epLRP. No statistical difference was found between the preoperative characteristics and the pathological results of cT1a,b vs. T1c/cT2 patients, or tpLRP vs. epLRP patients. Thirty-three procedures were completed laparoscopically and 2 were converted to open surgery. Perioperative complications included two leaking anastomoses, prolonged lymph drainage in 1 case, atelectasis (n = 1) and duodenal ulcer (n = 1). Twelve positive margins were noted, half of them in pT2 tumors. The mean follow-up was 28.5 months. Twenty-five of 35 patients had more than 12 months of follow-up. Among them 19 patients were completely continent (76%) and 6 (24%), reported mild stress incontinence. Conclusions: Although LRP following TURP is sometimes more technically difficult, simple modifications in the operative strategy help facilitate surgery. LRP following TURP favorably compares to open radical prostatectomy after TURP and laparoscopy in non-TURP patients.

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Section: Discussionmentioning

confidence: 92%

“…Until December 2002, patients were operated using the transperitoneal technique, and since then by the extraperitoneal technique. Both techniques have been described several times before [1,7] and therefore only aspects influencing the dissection will be described.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

Katz

Borkowski²,

Hoznek³

et al. 2006

Urol Int

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“…Some authors prefer the transperitoneal approach based on the larger working space and better luminosity and others prefer the extraperitoneal counterpart, based on the lack of contact with the intraperitoneal organs (3)(4)(5)(6).…”

Section: Clinical Urology Doi: 101590/s1677-55382010000400008mentioning

confidence: 99%

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

et al. 2010

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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

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“…Our operation modifications were as follows: 1) We only used the extraperitoneal approach with 5 trocar positioning and another 5 mm suprapubic trocar was deleted [4], which increased the working room and decreased the likelihood of instrument collision. 2) A 3 cm vertical incision (Figure 1) was made infra-umbilically and carried down to the anterior rectus fascia.…”

Section: Discussionmentioning

confidence: 99%

Extraperitoneal Laparoscopic Radical Prostatectomy

Song

Zhang

et al. 2006

Archives of Andrology

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& A total of 28 patients with clinically localized prostate cancer (PCa) underwent extraperitoneal laparoscopic radical prostatectomy (EP-LRP). The mean operative duration was 309 (287 600) minutes. Estimated blood loss ranged from 380 to 1000 (mean 480) ml. At 3 to 5 days postoperatively, the catheter was removed. No open conversion was required and no patient presented postoperative complications. PSA level was less than 0.1 ng=ml at 3 months after surgery in all patients. At a mean follow-up of 10 (6 16) months, there were no biochemical failures. The extraperitoneal technique potentially decreased the risk of intra-abdominal complications and better approximated than open retropubic radical prostatectomy. In conclusion, EP-LRP is an effective, safe and precise technique.

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Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy

Cited by 127 publications

References 15 publications

Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

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

Extraperitoneal Laparoscopic Radical Prostatectomy

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