Laparoscopic Radical Prostatectomy: Extraperitoneal Approach

Abstract

Many modifications of laparoscopic radical prostatectomy (LRP) have been tried and different methods of LRP have been established as the open retropubic radical prostatectomy. The initial dissection for vasa deferentia and seminal vesicles, which was an essential part of LRP as an established transperitoneal approach, has been unnecessary, and extraperitoneal LRP is now standardized and the steps of the procedure more clearly defined. Here, we highlight extraperitoneal LRP and the literature is reviewed. Extraperitoneal LRP has the valuable advantages of usual laparoscopic surgery and open retropubic radical prostatectomy. Laparoscopic surgery supplies less pain and reduces morbidity, leading to earlier recovery for the patients and a magnified, superior view for the surgeons. The extraperitoneal approach offers the elimination of possible risks, such as bowel injury, ileus, intraperitoneal bleeding and urine leakage, and allows possible later adjuvant radiation. Moreover, it may reduce the operating time and offers the same functioning and early oncological results as the transperitoneal approach. Lymphocele, which is a definite disadvantage of extraperitoneal LRP, should not become an issue because nomograms have reduced the necessity of its enforcement. Although a final answer may be decided only after long-term follow-up, extraperitoneal LRP should become one of our standard procedures.