Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis

To conduct a comparative analysis of outcomes from 2 different surgical approaches, transperitoneal radical prostatectomy (TP-RP) and extraperitoneal radical prostatec-tomy (EP-RP) in minimally invasive surgery. A comprehensive search was conducted up to September 2022 using 5 online databases, namely PubMed, Cochrane, Scopus, EMBASE, and Science Direct. Studies were screened per the eligibility criteria, and outcomes included operative duration, estimated blood loss (EBL), hospital stay, operative complication, and positive surgical margin. Total of 13 studies compiled of 2387 patients were selected, with TP-RP and EP-RP performed on 1117 (46.79%) and 1270 (53.21%) patients, respectively. Six laparoscopy radical prostatectomy (LRP) studies and 7 robot-assisted radical prostatectomy (RARP) studies with 1140 and 1247 patients, respectively, were also included. The EP-RP demonstrated a marked advantage in terms of operative complications (Risk Ratio [RR] = 0.78, 95% CI = 0.62, 0.98; P = .04), but no significant difference concluded for operative duration, EBL, hospital stay, and surgical margin. In the RARP group, there was a significant difference in operative duration for EP-RARP and TP-RARP (Mean difference [MD] = −17.27, 95% CI = −26.89, −7.65; P = .0004), hospital stay (MD = −0.54, 95% CI = −0.94, −0.14; P = .008), and operative complications (RR = 0.7, 95% CI = 0.49, 0.99; P = .04). There were no noteworthy variations identified in EBL and surgical margin. Furthermore, the LRP group did not show any significant differences. This study shows that regardless of the techniques used, EP-RP has a lower risk of operative complications than TP-RP, with no significant difference in other outcomes.