| Abstract: | AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy(e RARP) vs transperitoneal robot-assisted radical prostatectomy(t RARP) in a single centre.METHODS: A total of 120 consecutive patients underwent 50 e RARP and 70 e RARP operations respectively by the same surgical team. Peri-operative and post-operative outcomes including blood loss, hospitalization, complications(Clavien grade), positive surgical margin(PSM) rates, continence and erectile function were compared. The performance of e RARP required several technical modifications. These included developmentof Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; cranial digital stripping of peritoneum for sucker port and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.RESULTS: Robotic console times were shorter with e RARP vs t RARP(145.1 min vs 198.3 min, P 0.0001). There were no significant differences in blood loss, PSM rates(e RARP 17.7% vs t RARP 22%) or complications(e RARP 8.5% vs t RARP 8%). A drain was used in all patients after t RARP and in 25/70 e RARP cases. Length of hospital stay was shorter after e RARP(mean 1.94 d vs 3.6 d, P 0.0002). There were no differences between techniques in continence or potency at 6 mo. e RARP required several technical modifications: development of Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.CONCLUSION: e RARP demonstrated advantages in surgical times, hospital stay and equivalence in PSM rates, complications and functional outcomes. e RARP is a useful alternative to t RARP especially in patients with adhesions, pre-existing inguinal hernias, or those unable to withstand steep Trendelenburg position. |
