Laparoscopic Radical Prostatectomy

Türk, I.; Değer, Serdar; Winkelmann, B.; Schönberger, B.; Loening, Stefan A.

doi:10.1159/000049748

Cited by 186 publications

(5 citation statements)

References 23 publications

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“…The 6-month follow-up figure was 85.9%. Guillonneau et al [16] and Türk et al [17] reported complete continence rates of 76% and 86%, respectively, at the 6-month followup. After a 6-month followup, 85% ( n = 969) of the 1,300 patients were completely continent, 11.9% ( n = 136) showed minimal stress incontinence, and 3.1% ( n = 35) needed >2 pads daily.…”

Section: Discussionmentioning

confidence: 99%

Complications, Urinary Continence, and Oncologic Outcomes of Laparoscopic Radical Prostatectomy: Single-Surgeon Experience for the First 100 Cases

et al. 2011

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Objective. The aim of the present study was to evaluate initial learning curves of laparoscopic radical prostatectomy (LRP) with regard to complications, urinary continence, and oncologic outcome. Materials and Methods. We retrospectively reviewed 100 consecutive patients with clinically localized prostate cancer. All 100 patients underwent LRP performed by the same urologist at one institution. Results: Mean operating time (208.4 ± 48.6 min), estimated blood loss (495.8 ± 436.5 mL), allogeneic blood transfusion rate (0%), and intraoperative complications diminished with surgical experience. Positive margin rate varied greatly among pathological stage (positive margin rates: pT2 = 20.5%; pT3 = 63.0%). A trend towards reduction of positive surgical margins in pT2 cases was apparent with increasing experience. Intraoperative and early complications occurred in 2.0% of patients. In all patients, 85.9% used none or no more than one pad per 24 h at 6 months postoperatively. Prostate-specific antigen recurrence was seen in only 2 patients. Conclusions. In the present series of 100 patients, our retrospective evaluation confirms that LRP provides satisfactory results.

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Section: Discussionmentioning

confidence: 99%

Complications, Urinary Continence, and Oncologic Outcomes of Laparoscopic Radical Prostatectomy: Single-Surgeon Experience for the First 100 Cases

et al. 2011

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“…A recent review of the open radical prostatectomy literature shows the incidence of positive surgical margins to ranges from 10 to 48% [ 24 ]. The positive margin rates for laparoscopic and robotic prostatectomy are relatively comparable and range between 5.7 and 29% [ 35 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

Transition from open to robotic-assisted radical prostatectomy is associated with a reduction of positive surgical margins amongst private-practice-based urologists

et al. 2007

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Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has not been determined if this phenomenon exists amongst non-fellowship-trained urologists in private practice. Herein, we describe the positive margin rates of two non-fellowship-trained private-practice urologists who converted from open radical retropubic prostatectomy to robot-assisted radical prostatectomy. The margin positivity data from two non-fellowship-trained private-practice urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy from each surgeon were compared with the first 50 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive surgical margin was defined as tumor present at the inked margin of the prostate. There was a significant decrease in the overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for surgeon 1 dropped from 44 to 20% and from 37 to 5.7%, respectively, after changing from open to robotic prostatectomy. For surgeon 2, the overall positive margin rate changed from 26 to 18% and the pT2 positive margin rate changed from 27.5 to 7% after converting. Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain negative surgical margins. With proper training this phenomenon does seem to apply to non-fellowship-trained urologists in private practice and can be realized within the first 50 cases performed.

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“…They hypothesized that the improvement in the quality of apical margins after laparoscopic removal was secondary to the improved visualization in the pelvis provided by the illuminated magnified optics and the minimal blood in the surgical field allowing a more accurate dissection of the apex. Other laparoscopic series are chronicled in Table 3 [10,11,12,13,14,15,16,17]. The reported positive margin rate after robotic-assisted laparoscopic prostatectomy in reported series ranges from 0-36.4% [18,19,20,21,22,23,24,25,26,27,28,29,30].…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Outcomes of Robotic Radical Prostatectomy

Patel¹,

Shah²,

Arend³

2006

TSW Urology

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Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and shortterm PSA outcomes of 500 robotic radical prostatectomies.Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM stage, Gleason's grade, tumor location, volume, specimen weight, seminal vesicle involvement, and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data were collected every 3 months for the first year, then every 6 months for a year, then yearly.The average preoperative PSA was 6.9 (1-90) with Gleason's score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), and 9 (2%); postoperatively, histopathologic analysis showed Gleason's 6 (44%), 7 (42%), 8 (10%), and 9 (4%); 10, 5, 63, 15, 5, and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b, and T4, respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1-100), 8% (101-200), 13% (201-300), 5% (301-400), and 8% (401-500). By stage, it was 2, 4, and 2.5% for T2a, T2b, T2c tumors; 23% (T3a), 46% (T3b), and 53% (T4a). For organ-confined disease (T2), the margin rate was 2.5% and it was 31% for nonorgan-confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle, and 11 (23%) multifocal. Ninety-five percent of patients (n = 500) have undetectable PSA (<0.1) at average follow-up of 9.7 months. Recurrence has only been seen with nonorgan-confined tumors. Of those patients with a minimum follow-up of 1 year (average 15.7 months), 95% have undetectable PSA (<0.1).Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall, positive margin rate. Shortterm biochemical recurrence-free survival has also been good. We believe that the precise dissection allowed by the advantages of laparoscopic robotic surgery will translate into excellent long-term oncologic outcomes. At this time, the lack of maturity of the PSA data prevent definitive comparison to the open approach.

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Laparoscopic Radical Prostatectomy

Cited by 186 publications

References 23 publications

Complications, Urinary Continence, and Oncologic Outcomes of Laparoscopic Radical Prostatectomy: Single-Surgeon Experience for the First 100 Cases

Complications, Urinary Continence, and Oncologic Outcomes of Laparoscopic Radical Prostatectomy: Single-Surgeon Experience for the First 100 Cases

Transition from open to robotic-assisted radical prostatectomy is associated with a reduction of positive surgical margins amongst private-practice-based urologists

Histopathologic Outcomes of Robotic Radical Prostatectomy

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