Laparoscopic radical prostatectomy: Initial experience and preliminary assessment after 65 operations

Abstract

BACKGROUND Our purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy. METHODS We describe an original technique of laparoscopic radical prostatectomy performed in 65 successive patients during 11 months. RESULTS Radical prostatectomy was performed entirely by laparoscopy in 59 patients (91%). The median operating time was 265 min, including times for lymphadenectomy performed in 33% of patients. Preoperative complications included one rectal injury, sutured laparoscopically with an uneventful postoperative course, and one epigastric artery injury which needed secondary open procedure. The transfusion rate was 15.4% (10 patients). Median postoperative vesical catheterization lasted 7 days. The reduction of postoperative pain allowed rapid discharge of patients, by the fourth postoperative day in 60% of consenting patients. As regards oncological results, resection margins were negative in 57 patients (87.7%). The last prostate‐specific antigen (PSA) assay was undetectable (<0.1 ng/ml) in 85.7% of the 42 patients in whom PSA was available more than 1 month after the operation. CONCLUSIONS Radical prostatectomy can be routinely performed by laparoscopy by an experienced team. Short‐term oncological data were identical to the results of conventional retropubic surgery, and morbidity was low. The laparoscopic approach could constitute in the future a technical improvement over radical prostatectomy if long‐term oncological results are confirmed and if improvement of intraoperative vision improves the functional results of this operation. Prostate 39:71–75, 1999. © 1999 Wiley‐Liss, Inc.

Recovery of Urinary Function After Radical Prostatectomy: Predictors of Urinary Function on Preoperative Prostate Magnetic Resonance Imaging

“…Anatomical open radical prostatectomy has been optimized over the last 30 years and continues to undergo constant refinement aiming to improve oncologic outcomes while at the same time preserving urinary and sexual function 4-7 . Minimal invasive laparoscopic radical prostatectomy and more recently robotic assisted approaches have been developed to duplicate and potentially improve the outcomes of open surgery 8-10 .…”

Contemporary Radical Prostatectomy

“…In the 1990s, laparoscopic prostatectomy techniques were developed [19]. However, due to the technical difficulty of the procedure, this operation failed to attain widespread use until the advent of the da Vinci robotic interface by Intuitive Surgical [20].…”

Laparoscopic radical prostatectomy

“…[2] Typically, 5 trocars are placed in a fan array (Figure 1): a 10 mm umbilical trocar for the laparoscope, another 10 mm trocar is placed on the right side on the lateral edge of the rectus muscle, a 5 mm trocar on the left lateral edge of the rectus abdominis muscle, and two more 5 mm trocars are inserted approximately 2 cm medial and superior to the anterior superior iliac spines. Pneumoperitoneum is usually obtained using a Veress needle.…”

“…[12] It aims to replicate the results that have been obtained by open radical retropubic prostatectomy while reducing the morbidity associated with surgery. Since its introduction, laparoscopic radical prostatectomy has undergone numerous modifications in surgical technique, including approach (transperitoneal[2] vs extraperitoneal[3]), anterior[4] and posterior[2] dissection, ascending[5] and descending[4] dissection, and most notably, robotic-assisted. As with all new techniques, the learning curve must be surmounted to become proficient, and modifications are made to improve outcome.…”