A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience

Abstract

Laparoscopic transperitoneal radical prostatectomy (LRP) is technically challenging in obese patients especially in those with a narrow and deep pelvis. We prospectively evaluated the surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients. All consecutive patients with BMI ≥30 Kg/m 2 who underwent LRP for localized prostate cancer by a single surgeon between January 2013 and May 2016 at our institution were included. The various clinical data including patients' demographic profile, peri-operative data, postoperative data and followup were recorded and analyzed. We demonstrate our surgical technique in a video of one such patient. A total of 31 patients were included in the study. The mean BMI was 31.74 Kg/m 2 . The clinical stage ≤T2 c and ≥T3 a were seen in 88.8% and 11.2% respectively. The D'Amico classification low /intermediate/high risk was seen in 25.2%, 47.4% and 25.4% patients respectively. The mean operating time and mean estimated blood loss were 193.9 min and 190.5 ml respectively. There were no conversions to open surgery. Blood transfusion was required in 2 (6.4%) patients. Right unilateral, left unilateral and bilateral nerve sparing was performed in 35.4%, 22.5% and 41.9% patients respectively. The mean hospital stay and mean catheterization time were 4.31 days and 10.8 days respectively. Intraoperative and postoperative complications were seen in 3 (9.6%) and 4 (12.9%) respectively. Positive surgical margins were found in 2 (6.4%) patients. At mean follow up of 15.1 months, the continence rate at 3 months and 12 months were 61.2% and 93.5% respectively. The potency rate at 12 months was 48.38% with biochemical recurrence of 9.6%. Laparoscopic transperitoneal radical prostatectomy in obese patients with clinically localized prostate cancer is technically feasible and safe, with acceptable peri-operative morbidity and excellent functional outcomes. However, this technically challenging procedure should be attempted by surgeons with significant expertise.