Extraperitoneal Approach For Robotic Radical Prostatectomy

An extraperitoneal approach has been described for both laparoscopic and robotic prostatectomy (18-20). We have successfully performed 15 Vattikuti Institute of Prostatectomy's with an extraperitoneal approach. The extraperitoneal space is developed with a balloon dilator in the standard fashion. The ports are placed closer to the pelvic bones than with the transperitoneal approach, otherwise, the remainder of the procedure is identical to the previously described transperitoneal approach. An advantage of this approach is that some of the complications, which are seen with a transperitoneal approach, such as ileus from an anastomotic leak or postoperative bowel obstruction do not occur. The drawbacks are increased operating time (averaging 40 minutes additional per case) because of difficulty in creating the extraperitoneal working space and an increased incidence of lymphocele formation and deep venous thrombosis. For this reason, our preferred approach is transperitoneal for the vast majority of our patients.

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