Pertinent issues related to laparoscopic radical prostatectomy

Abstract

Purpose: We describe the critical steps of the laparoscopic radical prostatectomy (LRP) technique and discuss how they impact upon the pertinent issues regarding prostate cancer surgery: blood loss, potency and continence.Results: A major advantage of LRP is the reduced operative blood loss. The precise placement of the dorsal vein complex stitch associated with the tamponading effect of the CO 2 pneumoperitoneum significantly decrease venous bleeding, which is the main source of blood loss during radical prostatectomy. At the Cleveland Clinic, the average blood loss of our first 100 patients was 322.5 ml, resulting in low transfusion rates.The continuous venous bleeding narrowed pelvic surgical field and poor visibility can adversely impact on nerve preservation during open radical prostatectomy. Laparoscopy, with its enhanced and magnified vision in a relatively bloodless field allows for excellent identification and handling of the neurovascular bundles.During open retropubic radical prostatectomy, the pubic bone may impair visibility and access to the urethral stump, and the surgeon must tie the knots relying on tactile sensation alone. Consequently, open prostatectomy is associated with a prolonged catheterization period of 2 -3 weeks. Comparatively, during laparoscopic radical prostatectomy all sutures are meticulously placed and each is tied under complete visual control, resulting in a precise mucosa-to-mucosa approximation.Conclusion: The laparoscopic approach may represent a reliable less invasive alternative to the conventional open approach. Despite the encouraging preliminary anatomical and functional outcomes, prospective randomized comparative trials are required to critically evaluate the role of laparoscopy for this sophisticated and delicate operation.

Robot‐assisted approach improves surgical outcomes in obese patients undergoing partial nephrectomy

“…It is noteworthy, however, that we did observe a significantly higher rate of intra‐operative blood transfusion in the OPN group but no difference in the rate of postoperative blood transfusion, which may suggest that the increased bleeding risk is attributable to technical factors. Pneumoperitoneum, which effectively tamponades minor bleeding vessels, may explain this difference .…”

The use of an endoscopic stapler vs suture ligature for dorsal vein control in laparoscopic prostatectomy: operative outcomes

“…LP has two primary differences from open prostatectomy for the control of the DVC. First, the standard CO 2 insufflation pressure of 15 mmHg used in laparoscopy causes relative tamponade of venous bleeding, contributing to decreased blood loss and easier control of the DVC [11]. Second, improved visualization afforded by the laparoscope might allow a more direct view of the DVC and easier sutured or stapled control.…”

Effect of positive end‐expiratory pressure on blood loss during retropubic and robot‐assisted laparoscopic radical prostatectomy

“…Although improvements in the technique for RRP have improved outcomes dramatically, blood loss during RRP is still a major concern because of the prostate's rich venous supply . The impact of significant intraoperative blood loss on the patient's outcome is multifactorial.…”

“…Although improvements in the technique for RRP have improved outcomes dramatically, blood loss during RRP is still a major concern because of the prostate's rich venous supply. 1,2 The impact of significant intraoperative blood loss on the patient's outcome is multifactorial. Patients with lower postoperative hemoglobin after orthopedic and colorectal surgeries have been associated with prolonged hospitalization, 3,4 and in RRP lower blood loss has been associated with better short-term and long-term outcomes.…”