Comments on the extraperitoneal approach for standard laparoscopic radical prostatectomy: what is gained and what is lost

Comparison of efficacy and safety of conventional laparoscopic radical prostatectomy by the transperitoneal versus extraperitoneal procedure

Worldwide, prostate cancer (PCa) is the second most common malignancy in males. We undertook a meta-analysis to compare the efficacy and safety of conventional laparoscopic radical prostatectomy with a transperitoneal (TLRP) approach, versus that of an extraperitoneal (ELRP) approach, for treatment of localized PCa. A comprehensive literature search retrieved 14 publications, with a total of 1715 patients. Meta-analysis of these studies showed that an ELRP approach was associated with a significantly shorter postoperative catheterization time (MD: 1.99; 95% CI: 0.52 to 3.54; P = 0.008), less blood transfusion rate (OR: 2.05; 95% CI: 1.03 to 4.06; P = 0.04), shorter intestinal function recovery time (MD: 0.08; 95% CI: 0.52 to 1.09; P < 0.0001) and shorter hospitalization days (MD: 2.71; 95% CI: 1.03 to 4.39; P = 0.002). In addition, our results showed no statistically significant differences between the two groups in operation time (MD: 19.39; 95% CI: −6.67 to 45.44; P = 0.014), intraoperative blood loss (MD: 4.89; 95% CI: −105.00 to 114.79; P = 0.93) and total complication rate (RR: 1.22; 95% CI: 0.86 to 1.74; P = 0.27). In summary, our meta-analysis showed that ELRP is likely to be a safe and feasible alternative for localized PCa patients compared with TLRP.

Managing urine leakage following laparoscopic radical prostatectomy with active suction of the prevesical space

Introduction

Urine leakage following laparoscopic radical prostatectomy (LRP) is a possible complication that may herald chronic urine incontinence. Intraoperative measures aiming to prevent this is not standardised.

Aim

Presentation of experience with active suction of the prevesical space in managing postoperative urine leakage.

Material and methods

At the Department of Urology, where laparoscopy of the upper abdomen and open RP were performed, a protocol for extraperitoneal LRP was established in 8/2008. Until 5/2011, 154 LRPs have been performed. Urine leakage from a suction drain appeared in 9 cases (5.8%). Permanent active suction (with a machine for Büllae thoracic drainage) of the prevesical space with negative pressure of 7-12 cm of H₂O was started immediately.

Results

Urine leakage started after a mean of 0.9 (0-2) days postoperatively and stopped after a mean of 8.1 (15-42) days. Leakage stopped with only suctioning in 7 cases. In one case, open re-anastomosis was performed on the 7^th postoperative day (POD). In another case, ineffective active suction was replaced on the 10^th POD by needle vented suction without effect and the leakage stopped following gradual shortening of the drain up to the 15^th POD.

Conclusions

Active suction of the prevesical space seems to be an effective intervention to stop postoperative urine leakage after laparoscopic radical prostatectomy.