Transperitoneal or Extraperitoneal Approach for Laparoscopic Radical Prostatectomy: A False Debate Over a Real Challenge

With our extensive experience of transperitoneal laparoscopic prostatectomy, we evaluated the advantages and disadvantages of the extraperitoneal approach by comparing 2 consecutive series of each procedure.We reviewed 200 consecutive procedures performed by 2 surgeons. A total of 100 transperitoneal procedures (designated group 1) were compared to the first 100 extraperitoneal cases (designated group 2).Mean operating time was 173 minutes in group 1 and shorter in group 2 at 163 minutes (p = 0.003). Mean blood loss (360 ml in group 1,375 ml in group 2) and transfusion rates (4% in group 1, 3% in group 2) were equivalent. There were no major complications. Minor complications were 10% in group 1 and 9% in group 2. There was no statistical difference in positive margin rate between groups 1 and 2.The 2 procedures are equivalent in terms of operative, postoperative and pathological data. Each surgeon has to choose considering personal experience, training and standardization.