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Extraperitoneal Robot-Assisted Radical Prostatectomy: Indications, Technique and Outcomes

  • Minimally Invasive Surgery (T Guzzo, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Extraperitoneal robot-assisted radical prostatectomy (eRARP) is an alternative to the more commonly employed transperitoneal RARP (tRARP) for treatment of clinically localized prostate cancer. The purpose of this review is to discuss indications in which eRARP would be a more favorable approach in comparison to tRARP. In addition, we will discuss the safety and technique of eRARP.

Recent Findings

Recently published work has highlighted the outcomes and safety of eRARP in comparison to tRARP; specifically that eRARP is not inferior to tRARP. In addition, eRARP may be preferred in certain circumstances. For example, Ludwig et al. recently discussed the concomitant repair of inguinal hernia during eRARP.

Summary

Extraperitoneal RARP is a safe and effective alternative to tRARP. With previous knowledge and experience with tRARP, urologists can adapt the extraperitoneal approach without difficulty. This approach is useful for specific situations in which tRARP may be challenging.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ball MW, Reese AC, Mettee LZ, et al. Safety of minimally invasive radical prostatectomy in patients with prior abdominopelvic or inguinal surgery. J Endourol. 2014;29(2):192–7.

    Article  PubMed  Google Scholar 

  2. •• Dal Moro F, Crestabu A, Valotto C, et al. Anesthesiologic effects of transperitoneal versus extraperitoneal approach during robot-assisted radical prostatectomy: results of a prospective randomized study. Int Braz J Urol. 2015;41:466–72. This is a rigorous look at the anesthetic effects of the various robotic approaches to RP, and confirms and quantifies what practitioners of each approach have anecdotally noted

    Article  PubMed  Google Scholar 

  3. Glascock JM, Winfield HN, Lung GO, et al. Carbon dioxide homeostasis during transperitoneal or extraperitoneal laparoscopic pelvic lymphadenectomy: a real-time intraoperative comparison. J Endourol. 1996;10:319–23.

    Article  CAS  PubMed  Google Scholar 

  4. Stranne J, Hugosson J, Lodding P. Post-radical retropubic prostatectomy inguinal hernia: an analysis of risk factors with special reference to preoperative inguinal hernia morbidity and pelvic lymph node dissection. J Urol. 2006;176:2072–6.

    Article  PubMed  Google Scholar 

  5. Twu CM, Ou YC, Yang CR, et al. Predicting risk factors for inguinal hernia after radical retropubic prostatectomy. Urology. 2005;66:814–8.

    Article  PubMed  Google Scholar 

  6. Stranne J, Johanson E, Nilsson A, et al. Inguinal hernia after radical prostatectomy for prostate cancer: results from a randomized setting and a nonrandomized setting. Eur Urol. 2010;58(5):719–26.

    Article  PubMed  Google Scholar 

  7. Lin BM, Hyndman ME, Steele KE, et al. Incidence and risk factors for inguinal and incisional hernia after laparoscopic radical prostatectomy. Urology. 2011;77:957–62.

    Article  PubMed  Google Scholar 

  8. Fukuta F, Hisasue S, Yanase M, Kobayashi K, et al. Preoperative computated tomography finding predicts for postoperative inguinal hernia: new perspective for radical prostatectomy-related inguinal hernia. Urology. 2006;68:267–71.

    Article  PubMed  Google Scholar 

  9. Nielsen ME, Walsh PC. Systematic detection and repair of subclinical hernias at radical retropubic prostatectomy. Urology. 2005;66:1034–7.

    Article  PubMed  Google Scholar 

  10. Celik O, Akand M, Gokhan E, et al. Laparoscopic radical prostatectomy alone or with laparoscopic herniorrhaphy. JSLS. 2015;19(4):1–7.

    Article  Google Scholar 

  11. Do M, Liatsikos E, Kallidonis P, et al. Hernia repair during endoscopic extraperitoneal radical prostatectomy: outcome after 93 cases. J Endourol. 2011;25:625–9.

    Article  PubMed  Google Scholar 

  12. • Ludwig WW, Sopko NA, Azoury SC, et al. Inguinal hernia repair during extraperitoneal robot-assisted laparoscopic radical prostatectomy. J Endourol. 2016;30(2):208–11. This manuscript demonstrates that placing mesh at the time of extraperitoneal robotic RP for a total extraperitoneal hernia repair is safe and effective, and does not predispose to mesh infections from spilled urine

    Article  PubMed  Google Scholar 

  13. Al-Shareef AH, Akin Y, Almouhissen T, et al. Effects of previous hernia repair on extraperitoneal robot-assisted radical prostatectomy: a matched-pair analysis study. J Endourol. 2015;29(10):1143–7.

    Article  PubMed  Google Scholar 

  14. Pavlovich CP. The technique of robotic nerve sparing prostatectomy: extraperitoneal approach. In: Mydlo JH, Godec CJ (eds.) Prostate Cancer. Elsevier Ltd; 2016.

  15. Jacobs BL, Montgomery JS, Dunn RL, et al. A comparison of extraperitoneal and intraperitoneal approaches for robotic prostatectomy. Surg Innov. 2012;19(3):268–74.

    Article  PubMed  Google Scholar 

  16. Madi R, Daignault S, Wood DP. Extraperitoneal vs. intraperitoneal robotic prostatectomy: analysis of operative outcomes. J Endourol. 2007;21:1553–7.

    Article  PubMed  Google Scholar 

  17. Chung JS, Kim WT, Ham WS, et al. Comparison of oncologic results, functional outcomes, and complications for transperitoneal versus extraperitoneal robot-assisted radical prostatectomy: a single surgeon’s experience. J Endourol. 2010.

  18. Madeb R, Dragan G, Knopf J, et al. Patient-reported validated functional outcome after extraperitoneal robotic-assisted nerve-sparing radical prostatectomy. JSLS. 2007;11:443–8.

    PubMed  PubMed Central  Google Scholar 

  19. Lee JL, Diaz RR, Cho KS, et al. Meta-analysis of transperitoneal versus extraperitoneal robot-assisted radical prostatectomy for prostate cancer. J Laparoendoscopic and Advanced Surgical Techniques. 2013;23:919–25.

    Article  Google Scholar 

  20. •• Ghazi A, Scosyrev E, Patel H, et al. Complications associated with extraperitoneal robot-assisted radical prostatectomy using the standardized Martin classification. Urology. 2013;81:324–33. A great article and review of outcomes and complications by one of the masters of extraperitoneal robotic RP in the USA

    Article  PubMed  Google Scholar 

  21. Ploussard G, Salomon L, Parier B, et al. Extraperitoneal robot-assisted laparoscopic radical prostatectomy: a single-center experience beyond the learning curve. World J Urol. 2013;31:447–53.

    Article  PubMed  Google Scholar 

  22. Lee JL, Diaz RR, Cho KS, et al. Lymphocele after extraperitoneal robot-assisted radical prostatectomy: a propensity score-matching study. Int J of Urology. 2013;20:1169–76.

    Article  Google Scholar 

  23. Davis JW, Achim M, Munsell M, et al. Effectiveness of postgraduate training for learning extraperitoneal access for robotic-assisted radical prostatectomy. J Endourol. 2011;25:1363–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Martin OD, Azhar RA, Clavijo R, et al. Single port radical prostatectomy: current status. J Robotic Surg. 2016;10:87–95.

    Article  Google Scholar 

  25. Barret E, Sanchez-Salas R, Kasraeian A, et al. A transition to laparoendoscopic single-site (LESS) radical prostatectomy: human cadaver experimental and initial clinical experience. J Endourol Soc. 2009;23:135–40.

    Article  Google Scholar 

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Authors and Affiliations

  1. James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alice Semerjian & Christian P. Pavlovich

Authors
  1. Alice Semerjian
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  2. Christian P. Pavlovich
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Corresponding author

Correspondence to Christian P. Pavlovich.

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Conflict of Interest

Alice Semerjian and Christian P. Pavlovich each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Minimally Invasive Surgery

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Semerjian, A., Pavlovich, C.P. Extraperitoneal Robot-Assisted Radical Prostatectomy: Indications, Technique and Outcomes. Curr Urol Rep 18, 42 (2017). https://doi.org/10.1007/s11934-017-0689-4

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  • DOI: https://doi.org/10.1007/s11934-017-0689-4

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