Laparoscopic prostatectomy: a comparative study between transperitoneal and extraperitoneal approachs during learning curve

Objective: To compare data pertaining to laparoscopic prostatectomyperformed transperitoneally and extraperitoneally during preliminaryexperience. Methods: The first 30 patients submitted totransperitoneally laparoscopic prostatectomy and 30 patientssubmitted to extraperitoneally laparoscopic prostatectomy during theperiod of 1999 to 2005 were retrospectively assessed. Surgical andoncological results, and functional outcomes such as potency andcontinence were analyzed, and results were compared between thetwo groups. Results: Average surgical time and intraoperative bloodloss were, respectively, 270 minutes and 290 ml in the extraperitonealgroup, and 330 minutes and 380 ml in the transperitoneal group. Nosignificant differences occurred regarding intraoperative complications,length of hospital stay, or Foley catheterization time. Patients submittedto the extraperitoneal approach experienced an earlier reintroductionof diet, decreased number of paralytic ileus cases, less morbid clinicalprogress of urinary fistulae, and reduced positive margin rates. Asto sexual potency and urinary continence, there were no significantdifferences between the two groups. Conclusion: Laparoscopic radicalprostatectomy is a complex and feasible procedure that can be usedfor the treatment of localized prostate cancer. Retroperitoneal approachpresents some advantages over transperitoneal approach and seemsto result in lower morbidity in the learning curve period.