Extraperitoneal Robot-Assisted Radical Prostatectomy

Abstract

AbstractRobot-assisted radical prostatectomy (RARP) is currently an accepted standard of care for the surgical management of localized prostate cancer. The minimally invasive nature of the robotic approach, when compared with open surgery, offers comparable oncological and functional outcomes, with potential added advantages including decreased blood loss, and shorter hospital stay and recovery period. While the transperitoneal approach (T-RARP) is the most commonly performed approach among robotic surgeons, similar oncological outcomes have been reported with the extraperitoneal approach (E-RARP). E-RARP is less adopted, owing to its perceived technical difficulty. This approach, however, has its merits, particularly in cases where intraperitoneal access may be problematic. Both T-RARP and E-RARP can be performed using either the conventional multi-port (MP) robotic system or the more recent single-port (SP) robotic system. With respect to E-RARP, there may be an increased adoption of the SP system, with purported advantages in terms of cosmesis, post-operative analgesic and opioid requirements, and duration of hospital stay. In this chapter, we will summarize the evolution of the extraperitoneal approach, transitioning from open to laparoscopic to MP robotic and, most recently, to SP robotic approaches. We will describe the technical steps relevant to E-RARP, using either the MP or the SP robotic system, and elaborate on some clinically pertinent nuances of both approaches.KeywordsExtraperitonealRobot-assisted radical prostatectomyProstate cancerSingle portMulti-port