Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy: A systematic review and meta-analysis

Panagiotis Kallidonis (Lead / Corresponding author), Bhavan Prasad Rai, Hasan Abdur Rahman Qazi, Roman Ganzer, Minh Do, Anja Dietel, Evangelos Liatsikos, Ghulam Nabi, Iason Kyriazis, Jens Uwe Stolzenburg

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    Objectives: To systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP). Methods: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6. months. Results: In all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of -0.30. days (95% confidence interval [CI] -0.35, -0.24) for the laparoscopic group and 1.09. days (95% CI -1.47, -0.70) for the robotic group (P <. 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; P <. 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; P = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; P = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; P = 0.01). Conclusion: This review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.

    Original languageEnglish
    Pages (from-to)267-279
    Number of pages13
    JournalArab Journal of Urology
    Issue number4
    Early online date31 Aug 2017
    Publication statusPublished - Dec 2017



    • Extraperitoneal
    • Laparoscopy
    • Minimally invasive
    • Prostatectomy
    • Robotic
    • Transperitoneal

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