4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

N, Barbosa Hdo; Tm, Siqueira; Barreto, Francualdo; Lg, Menezes; Mj, Luna; Aa, Calado

doi:10.1590/s1677-5538.ibju.2015.0323

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…Even recognizing that the operative time is not as relevant to the patient, the value could represent technical difficulties or indicate the lack of progression in any step of the surgery ( 3 ). A similar abrupt reduction in the operative time after only a few cases was described by several studies, suggesting that 15 to 25 cases is sufficient to achieve a mean operative time of 3-4 hours, and could represent the adaptation to laparoscopic instruments and maneuvers, suggesting that the principal steps were already learned ( 16 , 19 ). The amount of blood loss and length of hospital stay were stable and comparable to large series.…”

Section: Discussionsupporting

confidence: 75%

The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy

et al. 2017

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Introduction:This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP.Patients and Methods:110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used.Results:The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad).Conclusions:The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.

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Section: Discussionsupporting

confidence: 75%

The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy

et al. 2017

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“…Birkmeyer et al reported a variation in surgeon's technical skill based on peer-rated video-recording ( 17 ). Moreover, many studies reflect that during the learning curve a significant reduction in the average time to perform the urethral-bladder anastomosis, the estimated blood loss and the removal time of the urinary catheter have not caused any important complication while performing ELRP ( 3 , 18 ). Our research design is from a Cross-Sectional analytic study with a 7-years series (from 2008-2014) and may have discrepancies when compared to other studies due to study population, surgeon experience and surgical procedures, similar to Ploussard et al report ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…The keys to preventing complications of laparoscopic radical prostatectomy (LP) are meticulous preoperative evaluation of patients, magnetic resonance imaging (MRI) planning, and early diagnosis and management of complications ( 2 ). The extraperitoneal laparoscopic radical prostatectomy (ELRP) technique proved to be a safe and effective procedure in the treatment of prostate cancer when compared with the transperitoneal (TLRP) approach, with low morbidity ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

The association between the outcomes of extraperitoneal laparoscopic radical prostatectomy and the anthropometric measurements of the prostate by magnetic resonance imaging

et al. 2018

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Introduction and objectiveTo determine the association between the anthropometric measurements by magnetic resonance imaging (MRI) and perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy (ELRP).Materials and MethodsFrom 2008 to June 2016, 86 patients underwent preoperative MRI prior to undergoing ELRP for localized prostate cancer. We analyzed the associations between anthropometric measurements of MRI and the perioperative outcomes of patients who underwent ELRP.ResultsThe mean patient age was 69.61±8.30 years. The medians of operating time and blood loss were 2.30 hours and 725.30ml, respectively. The total post-surgical complication rate was 1.16%. The median hospital stay was 6.50 days. The pathological stages for T2 and T3 were 45.74% and 34.04%, respectively. The rate as positive surgical margins (PSMs) was 18.09% (pT2 and pT3; 6.38% and 9.57%). The angles between pubic bone and prostate gland (angle 1&2), were significantly associated with operative time and hospital stay, respectively (p<0.05). There was no correlation between the pelvimetry and positive surgical margin.ConclusionsThe findings of the present study suggest that anthropometric measurements of the MRI are related to operative difficulties in ELRP. This study confirmed that MRI planning is the key to preventing complications in ELRP.

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“…Hatta tek insizyonlu uygulamalar için LESS (laparoendoscopic single-site surgery) terimi kabul edilmiştir. [9] Literatürde iki ve dört trokar kullanılarak yapılan LRP'ler ile ilgili deneyimler bildirilmekle birlikte [10,11] sadece üç trokar kullanılan eLRP tanımlanmamıştır.…”

Section: Sonuçunclassified

“…4-port ekstraperitoneal LRP'nin prostat kanserinin tedavisinde düşük morbiditeye sahip, güvenli ve etkili bir cerrahi teknik olduğunu bildirmiştir. [11] Akita ve ark. 2-port LRP ile konvansiyonel 5-port LRP'yi karşılaştırmış ve kozmetik avantajın yanı sıra postoperatif ağrıda anlamlı azalma ortaya koymuştur.…”

Section: Bulgularunclassified

Üç port ve konvansiyonel ekstraperitoneal laparoskopik radikal prostastatektomi uygulanan hastalarda erektil fonksiyonun karşılaştırılması

Ateş¹,

Akın²,

Kol³

et al. 2019

Androl Bul

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Günümüzde, klinik olarak organa sınırlı prostat kanserinin (PCa) cerrahi tedavi seçeneği radikal prostatektomidir (RP). [1] Radikal prostatektomide hedef hastalığın onkolojik eradikasyonunu sağlarken, yaşam kalitesinin devamlılığı için önemli olan kontinans ve erektil fonksiyonları korumaktır. [2] Onlarca yıl açık cerrahi teknik ile RP lokalize PCa'da standart cerrahi tedavi yöntemi olarak kabul edildi. [3] 1991 ABSTRACT OBJECTIVE: We aimed to compare the early postoperative erectile functions of patients who underwent extraperitoneal laparascopic radical prostatectomy (eLRP) with 3-port and conventional methods for prostate cancer. MATERIAL and METHODS: We reviewed the medical records of the patients who underwent radical prostatectomy between September 2016 and October 2018 retrospectively. The patients were divided into two groups as 3-ports eLRP and conventional eLRP. International erectile function index-5 (IIEF-5) form was used preoperatively and postoperatively at the 6th month to evaluate the erectile function of the patients. Patients with IIEF-5 score >21 were considered as potent, and IIEF-5<11 was considered as severe erectile dysfunction (ED). IIEF-5 scores of preoperatively potent patients who underwent 3-port eLRP and conventional eLRP were compared at postoperative 6th month. RESULTS: In total, 92 patients who underwent eLRP were included in the study. Of these, 23 were 3-port eLRP, 69 were conventional eLRP patients. Mean age was 63.4±6.10 years, mean prostate specific antigen (PSA) was 10.7±8.55 ng/dl. There were no statistically difference between compared groups in terms of age, PSA, preoperative and postoperative Gleason score, clinical and pathological stage, neurovascular bundle protection, positive surgical margin, postoperative continence status and postoperative erectile function 6th month. CONCLUSION: The 3-port eLRP, which is similar to the conventional method in terms of oncologic, surgical and early functional results, can be preferred as a minimally invasive surgical approach in the treatment of prostate cancer by maintaining erectile functions with better cosmetic results.

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4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

Cited by 4 publications

References 29 publications

The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy

The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy

The association between the outcomes of extraperitoneal laparoscopic radical prostatectomy and the anthropometric measurements of the prostate by magnetic resonance imaging

Üç port ve konvansiyonel ekstraperitoneal laparoskopik radikal prostastatektomi uygulanan hastalarda erektil fonksiyonun karşılaştırılması

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