Extraperitoneal Laparoscopic Radical Prostatectomy

Abstract

Initially described as “extraperitoneal endoscopic radical retropubic prostatectomy,” this novel approach for the treatment of prostate cancer avoids the potential disadvantages of the transperitoneal route of dissection. As the peritoneal cavity is never entered, complications like small bowel injury, urine ascites, small bowel obstruction, and intraperitoneal bleeding without the possibility of tamponade are almost nonexistent. In addition, the occurrence of postoperative ileum is diminished. The extraperitoneal approach more closely reproduces the open retropubic radical prostatectomy technique, as the steps of the operation are almost identical. However, the pelvic and prostate anatomy is magnified during laparoscopy, making dissection of important structures much more precise. Although still considered a complex procedure, extraperitoneal laparoscopic radical prostatectomy is an evolving technique and has gained popularity in the last years. It is a safe procedure and, in experienced hands, yields oncologic and functional results equivalent to the open approach.