Comparison of Approaches

Transperitoneal and extraperitoneal laparoscopic radical prostatectomy were compared by Hoznek et al. (25). In this retrospective study, the last 20 patients receiving transperitoneal laparoscopic radical prostatectomy were compared with the first 20 patients undergoing extraperitoneal laparoscopic radical prostatectomy. The operative time for extraperitoneal laparoscopic radical prostatectomy was significantly shorter (2.9 vs. 3.8 hours, P < 0.001), and resumption of a regular diet was significantly quicker (mean 1.6 vs. 2.6 days, P = 0.002). The duration of catheterization (4.2 vs. 5.3 days) and positive margin rates (25% vs. 15%) were similar between the two groups. Because of the preliminary nature of this paper, long-term cancer control rates and quality of life measures (potency, urinary continence) were not available. The authors concluded that the shorter operative time and the equivalent or superior morbidity and convalescence results indicated a significant advantage of the extraperitoneal technique over the transperitoneal technique.

A recent, retrospective study analyzing 100 consecutive extraperitoneal laparo-scopic radical prostatectomy and 100 consecutive transperitoneal laparoscopic radical prostatectomy at the Montsouris Institute showed no significant differences in operative time (2.8 vs. 2.9 hours), transfusion rate (3% vs. 4%), or positive surgical margin rate (21% vs. 15%) between the two groups and the authors highlighted in their conclusion the importance of the individual surgeon's training and experience in determining the optimal technique to use (26).

One of the major limitations to the use of robotic devices in prostate surgery is the cost. The da VinciĀ® surgical robot requires a tremendous capital investment, and the laparoscopic instruments used by the master-slave robot have preprogrammed senescence so that they can be used for only a finite number of procedures before they must be replaced. Additionally, the annual maintenance and per-case disposable instruments costs limit the widespread implementation of such device.

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