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

Abstract

Laparoscopic extraperitoneal radical prostatectomy (LERP) is considered the standard care treatment option for the management of localized and locally advanced prostatic cancer (PCa) in many institutes worldwide. In this work, the main advantages and disadvantages of LERP approach are reviewed with regard to its outcomes, the complication management, the learning curve, and the extend of pelvic lymph node dissection (PLND). It is concluded that LERP demonstrates comparable cancer control, urinary continence, and potency outcomes with the open and the robot-assisted radical prostatectomy, while offering advantages in complication management in comparison to the transperitoneal approach. Learning curve of LERP is considered long and stiff and significantly affects perioperative outcomes and morbidity, cancer control, and functional results. Thus, close mentoring especially in the beginning of the learning curve is advised. Finally, LERP still has a role in the limited or modified PLND offered in intermediate risk PCa patients.

Managing urine leakage following laparoscopic radical prostatectomy with active suction of the prevesical space.

“…Pelvic lymph node dissection (PLND) as a part of the RP was performed in 6 cases; in 5 as a modified procedure. In 1 case an extended PLND was performed [11]. The endopelvic fascia is opened on both sides of the prostate and the Santorini plexus (dorsal vein complex) is ligated with polyglactin suture.…”

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

“…However, both approaches to conventional LRP are routinely used in urological practice: the transperitoneal LRP (TLRP) and the extraperitoneal LRP (ELRP). Both approaches have been touted as efficacious and safe techniques by which to perform LRP 6 7 8 9 10 11 ; however, whether TLRP is superior to ELRP in terms of efficacy and safety has become a subject of controversy in recent years. We performed a meta-analysis to assess the safety and efficacy of TLRP and ELRP.…”