Laparoscopic Radical Prostatectomy: Preliminary Results

Abstract

Background: Retropubic and perineal radical prostatectomy are used for curative treatment of localized prostate cancer. More complex urological procedures are now being done with laparoscopy. We present our initial results of transperitoneal laparoscopic radical prostatectomy.Materials and Methods: Twenty laparoscopic radical prostatectomies were performed between May 1998 and May 1999. The mean age at the time of surgery was 64.2 years. There were 14 stage T1c, 5 stage T2a and 1 stage T2b tumors. The preoperative PSA was 9.3 ng/ml (normal <4 ng/ml). The Gleason score for positive specimens in 6 random echo–guided endorectal biopsies was 5.7. Four trocars were used. Insufflation pressure was 15 mmHg. The seminal vesicles were first dissected. The prostate was dissected free from the anterior face of the rectum to the prostate apex. Then the peritoneum was incised to find the apex of the prostate. The puboprostatic ligaments were isolated and cut, and the dorsal vein complex was ligated and cut to expose the urethra. The bladder neck was opened and dissected free from the prostate. The lateral pedicles were coagulated before sectioning the urethra. The radical prostatectomy specimen was left along the sigmoid colon, the bladder neck was reconstructed, and a urethrovesical anastomosis was performed with 6 interrupted sutures. The prostatectomy specimen was removed intact in a sack by enlarging the umbilical trocar port. All the prostatectomy specimens were processed according to the Standford protocol. Prostate weight, tumor weight, the Gleason score, and the tumor status of the capsule, seminal vesicles, lymph nodes and surgical margins were studied.Results: The operating time was 385 min. Two patients were transfused. The mean hospital stay was 7.8 days. The Foley catheter was removed 10.7 days after the operation. Specimen weight was 61 (28–126) g, the Gleason score was 5.9, and tumor volume was 1.4 ml. There were 18 stage pT2, 1 stage pTa (capsular effraction) and 1 stage pT3b (seminal vesicle invasion) tumors. There were four positive surgical margins (2 at the apex and 2 at the bladder neck). All the patients had a postoperative PSA level <0.1 ng/ml at 1 month. The first patient had urethrovesical anastomotic leakage, and required Foley catheterization for 21 days. There was 1 colostomy for rectal injury and 1 urinoma because of urethrovesical anastomotic leakage that required an open surgical procedure. One month after surgery, 15 (75%) patients were fully continent. Six patients had erections, and 5 stated having sexual intercourse.Conclusion: These preliminary results show that radical prostatectomy can be performed laparoscopically. Laparoscopy offered excellent vision of all the anatomical structures of the pelvis, permitting precise dissection. Long–term follow–up and further studies are required to confirm and improve these results.

Technique of laparoscopic (endoscopic) radical prostatectomy

“…Rassweiler et al [9] reported a rate of positive surgical margins in pT2 tumours of 2.3%, in pT3a of 15% and in pT3b of 34%. These results compare with those of other smaller series [14]. In our experience with EERPE the rate of positive surgical margins for pT2 tumours was 6.1% and for pT3 29.4% [13].…”

Laparoscopic Radical Prostatectomy

“…Recently, they presented their experience with 260 cases [14]. Another Paris group reported about their success of laparoscopic radical prostatectomy in 20 patients [4]. At first, we oriented ourselves by the technique described by Guillonneau and Vallancien with the aim of verifing its feasibility and its possible use a standardized procedure.…”

“…After they had to convert to open surgery in 7 patients initially, this was in no case necessary after their 60th procedure. Abbou’s group [4]also reported a conversion rate of 0%. An important advantage of laparoscopic prostatectomy is the minimal blood loss.…”

“…In some centers laparoscopic retroperitoneal lymphadenectomy (stage I testicular cancer) or laparoscopic radical tumor nephrectomy and/or nephroureterectomy belong to the therapeutical spectrum in the treatment of urological malignancies [2]. New to this spectrum is laparoscopic radical prostatectomy [3, 4]. Laparoscopy, in addition to the generally recognized lower postoperative morbidity, also allows for a better field of vision of the surgical site.…”

Prostatectomía radical laparoscópica extraperitoneal: Resultados de una curva de aprendizaje después de 310 casos

“…Sin embargo, la serie inicial demostró resultados más bien desalentadores 3,4 . En el año 2000, los trabajos de Guillonneau y Vallancien demuestran por primera vez la factibilidad técnica de la prostatectomía radical laparoscópica, realizada por vía transperitoneal, con resultados aceptables y que han sido reproducidos en otros centros alrededor del mundo [5][6][7][8] . Con el propósito de imitar la vía extraperitoneal de la prostatectomía radical retropúbica, es que Bollens por primera vez describe esta técni-ca por una vía exclusiva preperitoneal, con buenos resultados 9 .…”