Laparoscopic radical prostatectomy: 10 years experience

Mariano, Mirandolino Batista; Tefilli, Marcos V.; Fonseca, Gilvan N.; Goldraich, Isidoro Henrique

doi:10.1590/s1677-55382009000500008

Cited by 14 publications

(7 citation statements)

References 18 publications

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“…Similarly to our results, Mirandolino et al ( 6 ) reported that the PSM average obtained in cases under LRP was from 11%-26%.…”

Section: Discussionsupporting

confidence: 92%

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

Barreto

et al. 2016

Int. braz j urol.

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Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer.Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon.Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out.Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter.Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.

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“…Similarly to our results, Mirandolino et al ( 6 ) reported that the PSM average obtained in cases under LRP was from 11%-26%.…”

Section: Discussionsupporting

confidence: 92%

“…In a series of 760 cases, Mirandolino et al ( 6 ) found that the percentage of PSM in LRP was similar to the studies using the open technique. The PSM average was from 11% to 26%.…”

Section: Introductionsupporting

confidence: 65%

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

Barreto

et al. 2016

Int. braz j urol.

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“…Since the main goal of LRP is oncologic success, initial experience could be based on a PSM rate that should be 0%, but in practice 15% is considered acceptable. Our PSM rates were 20% in pT2 and 43.6% in pT3 with no statistical improvement with experience, were comparable to many previous reports ( 2 , 3 , 11 , 12 , 20 , 24 ), although it was higher than series with PSM rates between 7.2 and 13.9%, probable due to the higher proportion of pT3 in our series ( 22 , 25 ). Many studies also described a plateau in the PSM after 250 cases ( 3 , 7 , 23 ), while for others the plateau occurred after 100 cases ( 26 ).…”

Section: Discussionsupporting

confidence: 87%

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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“…). Following assessment, 68 articles, involving 708 032 patients across 71 LMICs, were included in the review ( Tables S1 and S2 , supporting information). Country‐specific patient numbers were reported in 60 studies but were absent from six and two provided total LMIC patient numbers only.…”

Section: Resultsmentioning

confidence: 99%

“…Outcomes following cancer surgery were common topics, including breast, gastric, colorectal and prostate cancer, and hepatocellular carcinoma. Cardiac surgery, caesarean section and genitourinary fistula were also well represented in included articles, whereas clinical presentations included burn management, trauma, appendicitis, groin hernias and orthopaedic fracture management.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of the use of big data to improve surgery in low- and middle-income countries

Knight

Ots

Maimbo

et al. 2019

British Journal of Surgery

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Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.

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Laparoscopic radical prostatectomy: 10 years experience

Cited by 14 publications

References 18 publications

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

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

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

Systematic review of the use of big data to improve surgery in low- and middle-income countries

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