Transperitoneal Versus Extraperitoneal Approach in Laparoscopic Radical Prostatectomy: A Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2018 Jul 20

PMID 30024501

Citations 7

Authors

Kun Wang

Qianfeng Zhuang

Renfang Xu

Hao Lu

Guanglai Song

Jianping Wang

Zinong Tian

Qingyan Mao

Pengfeng Gong

Affiliations

Soon will be listed here.

Abstract

Background: To compare the transperitoneal approach with extraperitoneal approach in laparoscopic radical prostatectomy (LRP) (including pure and robotic-assisted LRP) using meta-analytic techniques.

Methods: Medline (PubMed), Embase, Ovid, CMB, and Cochrane databases were searched for studies that compared the transperitoneal and extraperitoneal approaches in LRP from January 2000 to January 2017. Outcomes included were operative time, operative bloods joss (milliliters), rate of transfusion, rate of open conversion, rate of intraoperative complications, rate of postoperative complications, and time of postoperative catheterization.

Results: Thirteen studies including 1674 patients were selected for the meta-analysis. 850 (50.8%) cases had undergone transperitoneal LRP (TLRP) and 824 (49.2%) cases had undergone the extraperitoneal LRP (ELRP). Comparison of operative time between the TLRP group and the ELRP group showed no significant differences (weighted mean difference [WMD] = 21.21,95%CI = -1.16-43.57, P = .06). No significant differences were observed in blood loss (WMD = -6.04, 95%CI = -43.38-31.29, P = .75) and the rate of transfusion (odds ratio [OR] = 1.03, 95%CI = 0.55-1.96, P = .92) between the 2 groups. No significant differences were observed for the rate of intraoperative complications (OR = 1.25, 95%CI = 0.57-2.21, P = .75) and the rate of open conversion (OR = 1.12, 95%CI = 0.32-4.97, P = .75). Significant differences were observed in the TLRP group compared with the ELRP group (OR = 1.69, 95%CI: 1.23-2.32, P = .001) regarding the rate of postoperative complications.

Conclusions: Our meta-analysis findings revealed that the TLRP group showed no significant differences in most important indicators compared with ELRP. Moreover, TLRP showed higher rate of postoperative complications compared with ELRP.

Citing Articles

Extraperitoneal Robot-Assisted Radical Prostatectomy with the Hugo™ RAS System: Initial Experience at a High-Volume Robotic Centre.

Scarcia M, Filomena G, Moretto S, Marino F, Cotrufo S, Francocci A J Clin Med. 2024; 13(19).

PMID: 39407976 PMC: 11477504. DOI: 10.3390/jcm13195916.

Clinical study of 3D laparoscopic radical prostatectomy by transperitoneal and extraperitoneal approaches.

Fu J, Luo W, Ding Y, Liu X, Fang W, Yang X Am J Clin Exp Urol. 2023; 11(6):549-558.

PMID: 38148938 PMC: 10749385.

Predictive value of systematic immune-inflammation index combined with Ki-67 index on prognosis of prostate cancer patients after laparoscopic radical prostatectomy.

Wu R, Hu M, Zhang P BMC Urol. 2023; 23(1):210.

PMID: 38114926 PMC: 10729478. DOI: 10.1186/s12894-023-01379-3.

Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Purnomo S, Hamid A, Siregar M, Afriansyah A, Mirza H, Seno D Urol Res Pract. 2023; 49(5):285-292.

PMID: 37877876 PMC: 10646806. DOI: 10.5152/tud.2023.23008.

Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery.

Marques-Monteiro M, Teixeira B, Mendes G, Rocha A, Madanelo M, Mesquita S World J Urol. 2023; 41(10):2671-2677.

PMID: 37668717 DOI: 10.1007/s00345-023-04571-0.

References

Papachristos A, Basto M, Te Marvelde L, Moon D . Laparoscopic versus robotic-assisted radical prostatectomy: an Australian single-surgeon series. ANZ J Surg. 2014; 85(3):154-8. DOI: 10.1111/ans.12602. View

Deeks J, Dinnes J, DAmico R, Sowden A, Sakarovitch C, Song F . Evaluating non-randomised intervention studies. Health Technol Assess. 2003; 7(27):iii-x, 1-173. DOI: 10.3310/hta7270. View

Pasticier G, Rietbergen J, Guillonneau B, Fromont G, Menon M, Vallancien G . Robotically assisted laparoscopic radical prostatectomy: feasibility study in men. Eur Urol. 2001; 40(1):70-4. DOI: 10.1159/000049751. View

Eden C, King D, Kooiman G, Adams T, Sullivan M, Vass J . Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: does the approach matter?. J Urol. 2004; 172(6 Pt 1):2218-23. DOI: 10.1097/01.ju.0000144640.26182.41. View

Ganzer R, Stolzenburg J, Wieland W, Brundl J . Anatomic study of periprostatic nerve distribution: immunohistochemical differentiation of parasympathetic and sympathetic nerve fibres. Eur Urol. 2012; 62(6):1150-6. DOI: 10.1016/j.eururo.2012.03.039. View

Bivalacqua T, Schaeffer E, Alphs H, Mettee L, Wagner A, Su L . Intraperitoneal effects of extraperitoneal laparoscopic radical prostatectomy. Urology. 2008; 72(2):273-7. DOI: 10.1016/j.urology.2007.12.040. View

Porpiglia F, Terrone C, Tarabuzzi R, Billia M, Grande S, Musso F . Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy: experience of a single center. Urology. 2006; 68(2):376-80. DOI: 10.1016/j.urology.2006.02.039. View

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Cohen M, Triaca V, Silverman M, Tuerk I . Progression of laparoscopic radical prostatectomy: improved outcomes with the extraperitoneal approach and a running anastomosis. J Endourol. 2006; 20(8):574-9. DOI: 10.1089/end.2006.20.574. View

10.

Roumeguere T, Bollens R, Vanden Bossche M, Rochet D, Bialek D, Hoffman P . Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol. 2003; 20(6):360-6. DOI: 10.1007/s00345-002-0306-z. View

11.

Hakimi A, Blitstein J, Feder M, Shapiro E, Ghavamian R . Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: single-surgeon experience. Urology. 2008; 73(1):119-23. DOI: 10.1016/j.urology.2008.08.491. View

12.

Artibani W, Grosso G, Novara G, Pecoraro G, Sidoti O, Sarti A . Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy. Eur Urol. 2003; 44(4):401-6. DOI: 10.1016/s0302-2838(03)00315-4. View

13.

Athanasiou T, Al-Ruzzeh S, Kumar P, Crossman M, Amrani M, Pepper J . Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg. 2004; 77(2):745-53. DOI: 10.1016/j.athoracsur.2003.07.002. View

14.

Tewari A, Ali A, Metgud S, Theckumparampil N, Srivastava A, Khani F . Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing. World J Urol. 2013; 31(3):471-80. DOI: 10.1007/s00345-012-1018-7. View

15.

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

16.

Kaneko G, Miyajima A, Yuge K, Hasegawa M, Takeda T, Jinzaki M . Periprostatic fat area is an independent factor that prolonged operative time in laparoscopic radical prostatectomy. Urology. 2013; 82(6):1304-9. DOI: 10.1016/j.urology.2013.04.077. View

17.

Juan H, Yeh H, Li C, Wu W, Chou Y, Huang C . Complications of laparoscopic radical prostatectomy--a single institute experience. Kaohsiung J Med Sci. 2012; 28(10):550-4. DOI: 10.1016/j.kjms.2012.04.018. View

18.

Alshryda S, Mason J, Sarda P, Nargol A, Cooke N, Ahmad H . Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H). J Bone Joint Surg Am. 2013; 95(21):1969-74. DOI: 10.2106/JBJS.L.00908. View

19.

Asimakopoulos A, Corona Montes V, Gaston R . Robot-assisted laparoscopic radical prostatectomy with intrafascial dissection of the neurovascular bundles and preservation of the pubovesical complex: a step-by-step description of the technique. J Endourol. 2012; 26(12):1578-85. DOI: 10.1089/end.2012.0405. View

20.

Clarke M, Horton R . Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet. 2001; 357(9270):1728. DOI: 10.1016/S0140-6736(00)04934-5. View