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Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases.
Urology. 2005 Feb; 65(2):320-4.U

Abstract

OBJECTIVES

To compare the results of 122 transperitoneal laparoscopic radical prostatectomy (TP-LRP) procedures with those of 34 extraperitoneal LRP (EP-LRP) procedures to assess for differences in outcomes and complications. Both TP-LRP and EP-LRP have been touted as effective techniques for performing LRP.

METHODS

We retrospectively reviewed 156 LRPs performed by a single surgeon (D.M.D.) at a single institution between October 2001 and June 2003. EP-LRP was introduced in February 2003.

RESULTS

The cohorts were similar in terms of mean patient age, height, weight, body mass index, and American Society of Anesthesiologists Physical Status Classification. Of the total cohort, 19 TP-LRP (16%) and 11 EP-LRP (32%) patients had clinical Stage T2; the remainder had clinical Stage T1c. Similarly, 18 TP-LRP (15%) and 9 EP-LRP (26%) patients had a biopsy Gleason grade of 7 or greater. About one third of patients underwent concomitant pelvic lymphadenectomy (all negative), and 15 TP-LRP (12%) and 2 EP-LRP (6%) patients underwent simultaneous inguinal or umbilical herniorrhaphy. Six TP-LRP patients (5%) required significant lysis of bowel adhesions. The patients in both groups had similar mean operative times (197 minutes and 191 minutes for the TP-LRP and EP-LRP group, respectively; P = 0.29). Clinically significant anastomotic leaks were documented in 7 (6%) TP-LRP and 4 (12%) EP-LRP patients (P = 0.22). The two groups had similar mean hemoglobin decreases (3.0 g/dL) and transfusion rates. The mean time of drainage and hospitalization was 0.5 day longer for the TP-LRP cohort. A mean pathologic Gleason grade of 6.3 was noted for each cohort. Twenty-one TP-LRP (17%) and eight EP-LRP (24%) specimens were pathologic Stage T3, and 29 (24%) of the former and 7 (21%) of the latter (P = 0.81) specimens were margin positive. The complication rates were similar (11% and 12% in TP-LRP and EP-LRP groups, respectively; P = 1.0), except for a greater rate of ileus in the TP-LRP cohort (3 patients).

CONCLUSIONS

Extraperitoneal LRP appears to offer similar results to TP-LRP. TP-LRP was associated with a slightly greater ileus rate and EP-LRP with a slightly greater anastomotic leak rate (P = 0.22). However, the latter may have been the result of improved detection. Also, it was easier to manage using the EP-LRP approach.

Authors+Show Affiliations

Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA. jimbrown@mcg.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Review

Language

eng

PubMed ID

15708046

Citation

Brown, James A., et al. "Transperitoneal Versus Extraperitoneal Approach to Laparoscopic Radical Prostatectomy: an Assessment of 156 Cases." Urology, vol. 65, no. 2, 2005, pp. 320-4.
Brown JA, Rodin D, Lee B, et al. Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases. Urology. 2005;65(2):320-4.
Brown, J. A., Rodin, D., Lee, B., & Dahl, D. M. (2005). Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases. Urology, 65(2), 320-4.
Brown JA, et al. Transperitoneal Versus Extraperitoneal Approach to Laparoscopic Radical Prostatectomy: an Assessment of 156 Cases. Urology. 2005;65(2):320-4. PubMed PMID: 15708046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases. AU - Brown,James A, AU - Rodin,David, AU - Lee,Benjamin, AU - Dahl,Douglas M, PY - 2004/06/28/received PY - 2004/09/14/accepted PY - 2005/2/15/pubmed PY - 2005/10/6/medline PY - 2005/2/15/entrez SP - 320 EP - 4 JF - Urology JO - Urology VL - 65 IS - 2 N2 - OBJECTIVES: To compare the results of 122 transperitoneal laparoscopic radical prostatectomy (TP-LRP) procedures with those of 34 extraperitoneal LRP (EP-LRP) procedures to assess for differences in outcomes and complications. Both TP-LRP and EP-LRP have been touted as effective techniques for performing LRP. METHODS: We retrospectively reviewed 156 LRPs performed by a single surgeon (D.M.D.) at a single institution between October 2001 and June 2003. EP-LRP was introduced in February 2003. RESULTS: The cohorts were similar in terms of mean patient age, height, weight, body mass index, and American Society of Anesthesiologists Physical Status Classification. Of the total cohort, 19 TP-LRP (16%) and 11 EP-LRP (32%) patients had clinical Stage T2; the remainder had clinical Stage T1c. Similarly, 18 TP-LRP (15%) and 9 EP-LRP (26%) patients had a biopsy Gleason grade of 7 or greater. About one third of patients underwent concomitant pelvic lymphadenectomy (all negative), and 15 TP-LRP (12%) and 2 EP-LRP (6%) patients underwent simultaneous inguinal or umbilical herniorrhaphy. Six TP-LRP patients (5%) required significant lysis of bowel adhesions. The patients in both groups had similar mean operative times (197 minutes and 191 minutes for the TP-LRP and EP-LRP group, respectively; P = 0.29). Clinically significant anastomotic leaks were documented in 7 (6%) TP-LRP and 4 (12%) EP-LRP patients (P = 0.22). The two groups had similar mean hemoglobin decreases (3.0 g/dL) and transfusion rates. The mean time of drainage and hospitalization was 0.5 day longer for the TP-LRP cohort. A mean pathologic Gleason grade of 6.3 was noted for each cohort. Twenty-one TP-LRP (17%) and eight EP-LRP (24%) specimens were pathologic Stage T3, and 29 (24%) of the former and 7 (21%) of the latter (P = 0.81) specimens were margin positive. The complication rates were similar (11% and 12% in TP-LRP and EP-LRP groups, respectively; P = 1.0), except for a greater rate of ileus in the TP-LRP cohort (3 patients). CONCLUSIONS: Extraperitoneal LRP appears to offer similar results to TP-LRP. TP-LRP was associated with a slightly greater ileus rate and EP-LRP with a slightly greater anastomotic leak rate (P = 0.22). However, the latter may have been the result of improved detection. Also, it was easier to manage using the EP-LRP approach. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/15708046/Transperitoneal_versus_extraperitoneal_approach_to_laparoscopic_radical_prostatectomy:_an_assessment_of_156_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(04)01084-2 DB - PRIME DP - Unbound Medicine ER -