Laparoscopic Radical Prostatectomy: Extraperitoneal Approach

  • Ken Nakagawa
  • Masaru Murai
Part of the Recent Advances in Endourology book series (ENDOUROLOGY, volume 7)


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.


Laparoscopic radical prostatectomy Extraperitoneal approach Transperitoneal approach Comparison of approaches for LRP Advantages of extraperitoneal LRP 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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. 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
  3. 3.
    Nakagawa K, Murai M, Deguchi N, Baba S, Tachibana M, Nakamura K, Tazaki H (1995) Laparoscopic adrenalectomy: clinical results in 25 patients. J Endourol 9:265–267PubMedGoogle Scholar
  4. 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. 5.
    Nakagawa K (2003) Laparoscopic radical cystectomy. Urol View 1:79–85Google Scholar
  6. 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
  7. 7.
    Schuessler WW, Shulam PG, Clayman RV, Kavoussi LR (1997) Laparoscopic radical prostatectomy: initial short term experience. Urology 50:854–857CrossRefPubMedGoogle Scholar
  8. 8.
    Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancian G (1998) Prostatectomy radicale coelioscopique; premiere evaluation après 28 interventions. Presse Med 27:1570–1574PubMedGoogle Scholar
  9. 9.
    Raboy A, Ferzli G, Albert P (1997) Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology 50:849–853CrossRefPubMedGoogle Scholar
  10. 10.
    Bollens R, Vanden Bossche M, Roumeguere T, Damoun A, Ekane S, Hoffmann P, Zlotta AR, Schulmann CC (2001) Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol 40:65–69CrossRefPubMedGoogle Scholar
  11. 11.
    Nakagawa K (2005) Laparoscopic radical prostatectomy as a treatment for localized prostate cancer. Jpn J Endourol ESWL 18:58–63Google Scholar
  12. 12.
    Guillonneau B, Vallancian G (2000) Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 163:418–422PubMedGoogle Scholar
  13. 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
  14. 14.
    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. Eur Urol 46:312–320CrossRefPubMedGoogle Scholar
  15. 15.
    Fromont G, Guillonneau B, Validire P, Vallansian G (2002) Laparoscopic radical prostatectomy. Preliminary pathologic evaluation. Urology 60:661–665CrossRefPubMedGoogle Scholar
  16. 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
  17. 17.
    Guillonneau B, El-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, Vallancien G (2003) Laparoscopic radical prostatectomy: oncological evaluation after 1000 cases at Montsouris institute. J Urol 169:1261–1266PubMedGoogle Scholar
  18. 18.
    Ruiz L, Salomon L, Hoznek A, Vordos D, Yiou R, de la Taille A, Abbou CC (2004) Comparison of early oncologic results of laparoscopic radical prostatectomy by extraperitoneal versus transperitoneal approach. Eur Urol 46:50–56CrossRefPubMedGoogle Scholar
  19. 19.
    Stolzenburg JU, Do M, Rabenalt R, Pfeiffer H, Horn L, Truss MC, Jonas U, Dorschner W (2003) Endoscopic extraperitoneal radical prostatectomy: initial experience after 70 procedures. J Urol 169:2066–2071CrossRefPubMedGoogle Scholar
  20. 20.
    Cathelineau X, Cahill D, Widmer H, Rozet F, Baumert H, Vallancien G (2004) Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge. J Urol 171:714–716CrossRefPubMedGoogle Scholar
  21. 21.
    Stolzenburg JU, Truss MC, Rabenalt R, Do M, Pfeiffer H, Bekos A, Neuhaus J, Stief CG, Jonas U, Dorschner W (2004) Endoscopic extraperitoneal radical prostatectomy. Results after 300 procedures. Urologe A 43:698–707PubMedGoogle Scholar
  22. 22.
    Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, Baumert H, Vallancien G (2002) Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 167:51–56PubMedGoogle Scholar

Copyright information

© The Japanese Society of Endourology and ESWL 2006

Authors and Affiliations

  • Ken Nakagawa
    • 1
  • Masaru Murai
    • 1
  1. 1.Department of UrologyKeio University School of MedicineTokyoJapan

Personalised recommendations