You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2016MP69-13 EXTRAPERITONEAL VS. TRANSPERITONEAL ROBOT-ASSISTED RADICAL PROSTATECTOMY IN THE SETTING OF PRIOR ABDOMINAL OR PELVIC SURGERY David Horovitz, Changyong Feng, Edward M. Messing, and Jean V. Joseph David HorovitzDavid Horovitz More articles by this author , Changyong FengChangyong Feng More articles by this author , Edward M. MessingEdward M. Messing More articles by this author , and Jean V. JosephJean V. Joseph More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1391AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During Robotic-Assisted Radical Prostatectomy (RARP), the prostate may be accessed via an extraperiteoneal (eRARP) or transperitoneal (tRARP) approach. The former has been proposed as safer in patients who have had prior abdominal or pelvic surgery (PAPS) because intra-abdominal adhesions are avoided. Despite this, there have been no peer-reviewed articles comparing the two approaches in this setting. Our objective is to review the outcomes of patients with PAPS undergoing RARP using either approach. METHODS A retrospective review of patients treated with RARP from July 1, 2003-Dec. 31, 2014 with a minimum follow-up of 3 months was undertaken. Of 2,927 RARPs performed, 1,079 patients were identified has having undergone prior PAPS. 479 patients were excluded: 5 with a history or prior abdominopelvic radiation, 253 with a history of inguinal hernia repair with mesh, 221 with insufficient documentation of prior surgical history. Thus, the final group comprised 601 patients, of which 325 underwent eRARP and 276 underwent tRARP. Demographic data, surgical history, intra-operative details, pathology and complications were compared between the groups. RESULTS The tRARP group had a higher incidence of prior colorectal surgery (9.4% vs. 2.7%, p=0.001) and inguinal hernia without mesh (16.3% vs 4.9%, p<0.001) but there were no differences noted in any other types of prior surgery. Patients in the tRARP group were older (62.32 vs 60.96 yrs, p=0.013), had higher American Society of Anesthesiologists scores (2.20 vs. 2.12, p=0.03) and had higher D'Amico risk classification disease (p<0.0001). Body Mass Index and prostate weight were similar between groups. In the tRARP group, there was a higher incidence of ileus/partial small bowel obstruction/Ogilvie's (3.2% vs. 0.31%; p=0.007); there were no other differences noted in intra-operative, early post-operative, or late post-operative complications. There were no differences noted in Clavien I-II or III-IV complications. The tRARP group had a longer operating time (202.09 vs. 189.32 min, p=0.003) and a higher length of hospital stay (1.37 vs. 1.14 days, p=0.005). There were no differences noted in the rate of positive surgical margins, estimated blood loss or catheterization time. CONCLUSIONS In patients with PAPS, tRARP is safe. However, surgery may be more difficult as outlined by higher overall operating time. Bowel complications and overall hospital stay may be higher. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e902 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Horovitz More articles by this author Changyong Feng More articles by this author Edward M. Messing More articles by this author Jean V. Joseph More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Oct 20, 2018
C.E Hill-Kayser + 10
Open Access
