Comparative Study On The Clinical Effect Of Transperitoneal Approach And Extraperitoneal Approach For Laparoscopic Radical Prostatectomy

ObjectiveTo evaluation of perioperative clinical effect between transperitoneal laparoscopicradical prostatectomy and extraperitoneal laparoscopic radical prostatectomy.MethodsThe clinical data of63cases of patients underwent transperitoneal laparoscopicradical prostatectomy and50cases of patients underwent extraperitoneal laparoscopicradical prostatectomy were analyzed retrospectively at our institute between January2007and January2012.Indexes of preoperative BIM,preoperative PSA,preoperativeGlesson grade,c-TNM,operating time,bleeding volume during operation, bloodtransfusions rate,Postoperative Pain,recovery time of intestinal function,the durationof catheterization,hospitalization stay after operation,complication,p-TNM,continence rate,potency rate,and recurrence of the procedures were compared.Results1.Two groups were all successfully performed.1case of T-LRP group and1case ofE-LRP were converted to open surgery.The baseline data was no difference in twogroup.The BIM,preoperative PSA,preoperative Glesson grade,c-TNM and the volumeof prostate of T-LRP group and the E-LRP group,and there were statistical differencebetween these two groups(P＞0.05).2.The mean operating time of T-LRP group was longer than the E-LRP group,(325.6±95.6)minutes vs (213.8±100.5)minutes,and there was statistical differencebetween these two groups(P＜0.001);The mean bleeding volume durning operation ofT-LRP group was more than the E-LRP group,（398.9±200.6）ml vs（305.8±213.5）ml,there was statistical difference between these two groups(P=0.001);Theduration of catheterization of T-LRP group was longer than the E-LRP group,（14.43±4.54）days vs（12.34±5.32）days,there was statistical difference betweenthese two groups(P=0.037);The hospitalization of T-LRP group was longer than theE-LRP group,(14.54±6.45）days vs（12.64±5.32）days,there was statisticaldifference between these two groups(P=0.026).3.There was9cases with intraoperative complications in T-LRP group;There was4cases with intraoperative complications in E-LRP group;There was9cases withpostoperative complications in T-LRP group;There was9cases with postoperativecomplications in E-LRP group;and there were no statistical difference between twogroups.4.113patients were followed up for15~50months,and the median time was32months.By the end of the follow-up date,in the T-LRP group and E-LRP group,the one-year biochemical recurrence rate was4.76%（3/63）vs6.00%（3/50）;there was nostatistical difference between these two groups(P=0.134).In the T-LRP group andE-LRP group,the continence rare when pull the urine tube was22.2%（14/63）vs40.0%（20/50）;the six-month continence rate was55.5%（35/63）vs80.0%（40/50）,therewas statistical difference between these two groups(P=0.034,P＜0.001,separately).Butthere was no statistical difference between these two groups in the one-yearcontinence rate（P=0.324）.In T-LRP group,there were23cases(normal sexualfunction) and12cases(mildly abnormal sexual function),that had restored the sexualfunction after nerve-sparing radical prostatectomy.In the postoperation,24cases（68.6%）restore sexual function.In E-LRP group,there were18cases(normal sexualfunction) and8cases(mildly abnormal sexual function),that had restored the sexualfunction after nerve-sparing radical prostatectomy.In the postoperation,17cases（65.3%） restore sexual function.ConclusionCompared with E-LRP,T-LRP has larger space,and the tension is small invesicourethral anastomosis.The nerve,blood vessel bundle were easy to identify andretain them,moreover,it is more convenient to expand the pelvic lymph nodesdissection.Compared with T-LRP,E-LRP has his own advantage,such as the small ofintraoperative trauma,short operation time,fewer abdominal complications,quickerrecovery,etc.the two groups have the equivalent oncological and functionalresults,however ELRP is superior to T-LRP with respect to faster recovery ofcontinence.