Extraperitoneal Robot-Assisted Radical Prostatectomy: Simulating the Gold Standard

Abstract

For almost two decades, robot assisted radical prostatectomy (RARP) has been the preferred method at many institutions to remove a cancerous prostate. The shorter learning curve associated with RARP, when compared to laparoscopic radical prostatectomy, has facilitated its adoption in both academic and community settings. The extraperitoneal approach, which is common to open prostatectomists, is often abandoned as they transitioned to a robotic approach, due to difficutly developing the extraperitoneal space, and identifying extraperitoneal anatomical landmarks laparoscopically. The extraperitoneal route furthers the quest of minimal invasiveness, as it maintains the integrity of the abdominal cavity, and avoids potential lysis of adhesions in patients with prior abdominal surgeries. In this chapter, we provide a detailed review, which should prove useful to both expert and novice robotic prostatectomists, seeking to add the extraperitoneal approach to their surgical armamentarium.