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Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis.
Eur Urol. 2004 Sep; 46(3):312-9; discussion 320.EU

Abstract

PURPOSE

Based on the experience of 1000 cases of laparoscopic radical prostatectomy, we compared the operative parameters of transperitoneal and extraperitoneal approaches in match-paired patient groups.

PATIENTS AND METHODS

We reviewed the charts of 53 consecutive patients who underwent selectively extraperitoneal laparoscopic radical prostatectomy comparing it to 53 match-paired patients treated by transperitoneal laparoscopic radical prostatectomy. The patients were matched for age, PSA (ng/ml), prostate volume (g), pathologic stage, Gleason score, presence of pelvic lymph node dissection and type of nerve-sparing technique. Perioperative parameters (operating time, blood donation, complications) and postoperative results (duration and amount of analgesic treatment, catheterization time) as well as oncological (surgical margin status) and functional (continence rate) results were analyzed.

RESULTS

Patients were 62.9 +/- 5.5 versus 62.9 +/- 5.4 years old, had 27.5 +/- 3.5 kg/m2 versus 26.7 +/- 2.8 kg/m2 body mass indices in the extraperitoneal and transperitoneal groups, respectively. Preoperative mean PSA and prostate volume were 7.4 +/- 4.6 ng/ml and 41.8 +/- 16.3 g in the extraperitoneal, 7.6 +/- 3.8 ng/ml and 42.0 +/- 14.8 g in the transperitoneal group. Pathologic stages were T2a in 12 vs. 13, T2b in 21 vs. 20, T2c in 7 vs. 8, T3a in 11 vs. 10 and T3b in 2 vs. 2 patients for both groups. Overall 211.8 vs. 197.1 minutes mean operative time (p = 0.328) and 21.9 +/- 15.4 mg vs. 26.3 +/- 15.8 mg narcotic analgesic requirements (p = 0.111) did not differ significantly in both groups. However, mean operating time was significantly longer in the extraperitoneal group when performing pelvic lymphadenectomy (244.5 vs. 209.6 minutes, p = 0.017). There was no statistical difference of complication rate (4% vs. 2%) and median catheter time (7 vs. 7 days), positive surgical margins (22.6% vs. 20.7%) and 12 months continence (86.7% vs. 84.9%).

CONCLUSIONS

There was no significant difference between the extraperitoneal and transperitoneal approaches using the Heilbronn technique regarding all important parameters. In addition to the preference and experience of the individual surgeon, previous abdominal surgery, gross obesity and requirement of simultaneous inguinal hernia repair may be considered as selective indications for extraperitoneal laparoscopic radical prostatectomy.

Authors+Show Affiliations

Department of Urology, SLK Klinikum Heilbronn, Am Gesundbrunnen 20, D-77074, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15306100

Citation

Erdogru, Tibet, et al. "Comparison of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy Using Match-pair Analysis." European Urology, vol. 46, no. 3, 2004, pp. 312-9; discussion 320.
Erdogru T, Teber D, Frede T, et al. Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. Eur Urol. 2004;46(3):312-9; discussion 320.
Erdogru, T., Teber, D., Frede, T., Marrero, R., Hammady, A., Seemann, O., & Rassweiler, J. (2004). Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. European Urology, 46(3), 312-9; discussion 320.
Erdogru T, et al. Comparison of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy Using Match-pair Analysis. Eur Urol. 2004;46(3):312-9; discussion 320. PubMed PMID: 15306100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. AU - Erdogru,Tibet, AU - Teber,Dogu, AU - Frede,Thomas, AU - Marrero,Reinaldo, AU - Hammady,Ahmed, AU - Seemann,Othmar, AU - Rassweiler,Jens, PY - 2004/05/19/accepted PY - 2004/8/13/pubmed PY - 2005/2/3/medline PY - 2004/8/13/entrez SP - 312-9; discussion 320 JF - European urology JO - Eur Urol VL - 46 IS - 3 N2 - PURPOSE: Based on the experience of 1000 cases of laparoscopic radical prostatectomy, we compared the operative parameters of transperitoneal and extraperitoneal approaches in match-paired patient groups. PATIENTS AND METHODS: We reviewed the charts of 53 consecutive patients who underwent selectively extraperitoneal laparoscopic radical prostatectomy comparing it to 53 match-paired patients treated by transperitoneal laparoscopic radical prostatectomy. The patients were matched for age, PSA (ng/ml), prostate volume (g), pathologic stage, Gleason score, presence of pelvic lymph node dissection and type of nerve-sparing technique. Perioperative parameters (operating time, blood donation, complications) and postoperative results (duration and amount of analgesic treatment, catheterization time) as well as oncological (surgical margin status) and functional (continence rate) results were analyzed. RESULTS: Patients were 62.9 +/- 5.5 versus 62.9 +/- 5.4 years old, had 27.5 +/- 3.5 kg/m2 versus 26.7 +/- 2.8 kg/m2 body mass indices in the extraperitoneal and transperitoneal groups, respectively. Preoperative mean PSA and prostate volume were 7.4 +/- 4.6 ng/ml and 41.8 +/- 16.3 g in the extraperitoneal, 7.6 +/- 3.8 ng/ml and 42.0 +/- 14.8 g in the transperitoneal group. Pathologic stages were T2a in 12 vs. 13, T2b in 21 vs. 20, T2c in 7 vs. 8, T3a in 11 vs. 10 and T3b in 2 vs. 2 patients for both groups. Overall 211.8 vs. 197.1 minutes mean operative time (p = 0.328) and 21.9 +/- 15.4 mg vs. 26.3 +/- 15.8 mg narcotic analgesic requirements (p = 0.111) did not differ significantly in both groups. However, mean operating time was significantly longer in the extraperitoneal group when performing pelvic lymphadenectomy (244.5 vs. 209.6 minutes, p = 0.017). There was no statistical difference of complication rate (4% vs. 2%) and median catheter time (7 vs. 7 days), positive surgical margins (22.6% vs. 20.7%) and 12 months continence (86.7% vs. 84.9%). CONCLUSIONS: There was no significant difference between the extraperitoneal and transperitoneal approaches using the Heilbronn technique regarding all important parameters. In addition to the preference and experience of the individual surgeon, previous abdominal surgery, gross obesity and requirement of simultaneous inguinal hernia repair may be considered as selective indications for extraperitoneal laparoscopic radical prostatectomy. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/15306100/Comparison_of_transperitoneal_and_extraperitoneal_laparoscopic_radical_prostatectomy_using_match_pair_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302283804002696 DB - PRIME DP - Unbound Medicine ER -