Laparoscopic Radical Prostatectomy: Extraperitoneal Approach
Many modifications of laparoscopic radical prostatectomy (LRP) have been tried and different methods of LRP have been established as the open retropubic radical prostatectomy. The initial dissection for vasa deferentia and seminal vesicles, which was an essential part of LRP as an established transperitoneal approach, has been unnecessary, and extraperitoneal LRP is now standardized and the steps of the procedure more clearly defined. Here, we highlight extraperitoneal LRP and the literature is reviewed. Extraperitoneal LRP has the valuable advantages of usual laparoscopic surgery and open retropubic radical prostatectomy. Laparoscopic surgery supplies less pain and reduces morbidity, leading to earlier recovery for the patients and a magnified, superior view for the surgeons. The extraperitoneal approach offers the elimination of possible risks, such as bowel injury, ileus, intraperitoneal bleeding and urine leakage, and allows possible later adjuvant radiation. Moreover, it may reduce the operating time and offers the same functioning and early oncological results as the transperitoneal approach. Lymphocele, which is a definite disadvantage of extraperitoneal LRP, should not become an issue because nomograms have reduced the necessity of its enforcement. Although a final answer may be decided only after long-term follow-up, extraperitoneal LRP should become one of our standard procedures.
KeywordsLaparoscopic radical prostatectomy Extraperitoneal approach Transperitoneal approach Comparison of approaches for LRP Advantages of extraperitoneal LRP
Unable to display preview. Download preview PDF.
- 1.Schussler WW, Vancaillie TG, Reich H, Griffith DP (1991) Transperitoneal endo surgical lymphadenectomy in patients with localized prostate cancer. J Urol 145:988–991Google Scholar
- 2.Winfield HN, Donovan JF, See WA, Loening SA, Williams RD (1992) Laparoscopic pelvic lymph node dissection for genitourinary malignancies, indications, techniques, and results. J Endourol 6:103–109Google Scholar
- 4.Baba S, Nakagawa K, Nakamura K, Deguchi N, Hata M, Murai M, Tazaki H (1996) Experience of 143 cases of laparoscopic surgery in urology. Clinical outcome in comparison to open surgery. Jpn J Urol 87:842–850Google Scholar
- 5.Nakagawa K (2003) Laparoscopic radical cystectomy. Urol View 1:79–85Google Scholar
- 6.Nakagawa K, Ohigashi T, Nakashima J, Marumo K, Murai M (2002) Laparoscopic radical prostatectomy: clinical results in 37 cases. Urol Surg 15:829–832Google Scholar
- 11.Nakagawa K (2005) Laparoscopic radical prostatectomy as a treatment for localized prostate cancer. Jpn J Endourol ESWL 18:58–63Google Scholar
- 13.Hoznek A, Antiphon P, Borkowski T, Gettman MT, Katz R, Salomon L, Zaki S, De La Taille A, Abbou CC (2003) Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology 61:617–622CrossRefPubMedGoogle Scholar
- 16.Salomon L, Anastasiadis AG, Levrel O, Katz R, Saint F, de la Taille A, Cicco A, Vordos D, Hoznek A, Chopin D, Abbou CC (2003) Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer. Urology 61:386–390CrossRefPubMedGoogle Scholar