Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy: A systematic review and meta-analysis

Abstract

ObjectivesTo systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP).MethodsThe systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6 months.ResultsIn all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of −0.30 days (95% confidence interval [CI] −0.35, −0.24) for the laparoscopic group and 1.09 days (95% CI −1.47, −0.70) for the robotic group (P < 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; P < 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; P = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; P = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; P = 0.01).ConclusionThis review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.

Extraperitoneal single‐port robot‐assisted radical prostatectomy: initial experience and description of technique

“…Binder and Kramer [2] in 2001 first described RARP in a series of 10 patients, reporting a median operative time of 540 min and one conversion; these initial lengthy operative times decreased after accomplishing the learning curve, and a [10]. Our present median (range) total operative time was 197.5 (137-281) min, which is comparable with the durations published in the meta-analysis [10].…”

“…Binder and Kramer [2] in 2001 first described RARP in a series of 10 patients, reporting a median operative time of 540 min and one conversion; these initial lengthy operative times decreased after accomplishing the learning curve, and a [10]. Our present median (range) total operative time was 197.5 (137-281) min, which is comparable with the durations published in the meta-analysis [10]. We understand that our present study does not reflect a comparison between approaches, but we can use the present study as a reference for the extraperitoneal approach; despite this, with increased experience of the surgeon and the operative team, the operative time is expected to decrease.…”

Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience

“…Very large series of eLRP reported PSM rates of 10.8-16.1% and 31.2-34.6% in pT2 and pT3 cancers, respectively (19,24). However, comparative data between extraperitoneal and intraperitoneal LRP show no differences in terms of PSM (25,26), as well as no significant difference exist between open and laparoscopic RP (27). Regardless of the surgical technique, one of the most relevant predictors for PSM is tumor stage.…”

Technical advancements in robotic prostatectomy: single-port extraperitoneal robotic-assisted radical prostatectomy and single-port transperineal robotic-assisted radical prostatectomy

“…With this procedure, radical prostatectomy can be accomplished via a small 2-3 cm infraumbilical incision with no additional ports. Additionally, the extraperitoneal approach may be associated with a lower incidence of postoperative ileus and therefore a shorter hospital stay and quicker recovery (11). Since surgery is performed in supine position, unlike classic robotic prostatectomy, adverse effects associated with Trendelenburg positioning including ventilation difficulty, increases in intraocular, intracranial and intrathoracic pressures can be avoided (12).…”