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Should Robotic Assisted Radical Prostatectomy Be Extraperitoneal Like Open Surgery?
Kevin Tomera1, Brooke A Harnisch2, Jaspreet Batra1, Ingolf Tuerk1
1St. Elizabeth's Medical Center, Brighton, MA;2Boston University and Boston Medical Center, Boston, MA

The standard approach for open radical prostatectomy is extraperitoneal but most robotic surgeons have limited themselves to the transperitoneal approach. We compare our surgical and oncological Results for extraperitoneal (EP-RARP) to transperitoneal (TP-RARP) robotic assisted radical prostatectomy.
Materials & Methods:
We examined our departmental, IRB approved, retrospective database of RARP. Between October 2008 to March 2011, 611 patients underwent RARP of which 382 had EP-RARP.
EP-RARP was comparable to TP-RARP with mean operative times (126 vs. 124 minutes), estimated blood loss was identical at 150mls, similar nodal yield (8.3 vs. 8.5), low positive surgical margin rate (9.8 vs. 9.6%) despite 26% of patients having pT3 disease. Hospital stays were overnight (1.01 vs. 1.04 days) . The importance of lymphadenectomy is confirmed by our 9.6% yield. Major complications were only 0.6% with a small bowel obstruction and renal failure in the transperitoneal group (table attached).
The advantage of extraperitoneal approach for open surgery is avoiding bowel complications. An experienced robotic surgeon can perform extraperitoneal radical prostatectomy retaining this advantage without oncological or surgical compromise.
Table 1: EP-RARP vs. TP-RARP data

Age(mean+ s.d.)59.84+7.1859.49+7.0960.71+7.38
BMI kg/m228.3 +4.2627.2 +3.3131.0 +5.14
Number of pts with
BMI> 30kg/m2
PSA(ng/dl)5.9 +5.05.9 +5.16.0 +4.6
Prostate size49 +1949 +1750 +23
OR time( minutes)125 +21126 +20124 +24
EBL(ml) median150 +154150 +166150 +100
Pathologic stage
PSM- prostate surgical margins9.7%9.8%9.6%
Nodal Yield8.4 +4.28.3 +3.88.5 +5.3
Node positive9.6%6.4%13.6%
Post operative Complications (Clavien grade 4 number or greater)0.6% (4pts)STEMI x2Small bowel obstruction and renal failure; anastomotic disruption and renal failure
Length of stay1.031.011.04

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