Laparoscopic Radical Prostatectomy: The Montsouris Technique

Guillonneau, Bertrand; Vallancien, Guy

doi:10.1016/s0022-5347(05)67512-x

Cited by 582 publications

(250 citation statements)

References 7 publications

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“…The LRP performed was an evolution of the previously described Montsouris technique [18]. The first modification involved the apical dissection, with transection of the urethra at the end of the prostatectomy once the neurovascular bundles have been dissected off the apex and completely freed; the second modification is the intraoperative gross examination of the specimen before completion of the urethrovesical anastomosis, allowing frozen section examination of suspicious areas.…”

Section: Surgical Techniquementioning

confidence: 99%

Impact of a Multidisciplinary Continuous Quality Improvement Program on the Positive Surgical Margin Rate after Laparoscopic Radical Prostatectomy

et al. 2006

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Objective-Outcome after radical prostatectomy is highly sensitive to fine nuances in the surgical techniques. We sought to determine the impact of a process of continuous control and monitoring on the positive surgical margin rate in a contemporary series of laparoscopic radical prostatectomy.Methods-Between January 2003 and October 2004, 301 men underwent laparoscopic radical prostatectomy for clinically localized prostate cancer (cT1-cT3a). A weekly case review conference involving surgeons, radiologists, and uropathologists was held to discuss the preoperative, intraoperative, and pathologic findings of significant cases. We analyzed the trend of positive surgical margins and compared the clinical and detailed pathologic characteristics of the cancer during the study period.Results-We created logistic regression models with positive margin as the dependent variable and surgical experience as the predictor, adjusting for possible secular changes in disease severity (prostate-specific antigen, pathologic stage, and Gleason grade). There was a decrease in the rate of surgical margins: odds ratio 0.68/100 patients treated (95% confidence interval [CI] 0.44, 1.05; p = 0.08). The predicted probability for a positive surgical margin falls from 17.3% for the first patient to 7.5% for the 301st. These values are close to the observed rates for the first and last 50 patients. There was no important change in surgical risk over the course of the study, and the rate of nerve sparing remained stable throughout the study period.Conclusions-In this contemporary series, which is unaffected by downward stage migration, the decreasing rate of positive surgical margins can be explained by subtle surgical technique modifications and a continuous multidepartmental effort for quality improvement.

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Section: Surgical Techniquementioning

confidence: 99%

Impact of a Multidisciplinary Continuous Quality Improvement Program on the Positive Surgical Margin Rate after Laparoscopic Radical Prostatectomy

et al. 2006

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“…a team in Bordeaux introduced the transperitoneal dissection of the seminal vesicles. To date, Guillonneau and Vallancien [6] have published the largest series of LRP. Between 1998 and 1999 they developed the 'Montsouris technique', which is now accepted as a feasible and reproducible procedure, and used by an increasing number of groups in Europe and the USA, with slight modifications.…”

Section: The Surgical Technique Of Lrpmentioning

confidence: 99%

“…In the 'Montsouris technique' [6] the neurovascular bundles are systematically preserved using precise bipolar coagulation. We think that there is a considerable risk of thermal and electrical injury of the neurovascular bundles and the branches of the pelvic plexus, which are situated between the rectum and the urethra, with bipolar coagulation.…”

Section: Modification Of the Techniquementioning

confidence: 99%

Technique of laparoscopic (endoscopic) radical prostatectomy

Stolzenburg

Truß

2003

BJU International

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SUMMARYDuring the last decade laparoscopy has become a standard technique available to the urologist, through constant technological advances and refinements. The progress of laparoscopic/endoscopic techniques allows the indications for this surgery to include complex oncological procedures like radical prostatectomy. Since the first description of laparoscopic radical prostatectomy (LRP) in the early 1990s the technique has undergone significant technical modifications. Transperitoneal LRP is now a standard procedure and can be used successfully and reproducibly, giving results comparable with those from the open retropubic procedure. Despite many advantages, transperitoneal laparoscopy is associated with potential intraperitoneal complications. Because of the limitations inherent in the transperitoneal route, a totally extraperitoneal endoscopic radical prostatectomy (EERPE) has been developed. The totally extraperitoneal endoscopic access provides a safe and minimally invasive approach to various urological procedures, including prostatectomy. This technical improvement completely obviates intra‐abdominal complications. EERPE combines the advantages of minimally invasive laparoscopy and the open retropubic approach. We review the surgical techniques of LRP and EERPE, and highlight the indications, contraindications and outcomes.

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“…Although LRP was first performed in the United States in 1992, the procedure was considered 'too difficult' and without likely benefit, and further development of the procedure in the United States was effectively stalled [3]. However, in Europe, interest in LRP continued and the procedure enjoyed a new wave of popularity following the work by Guillonneau et al [4] in 1999. Outcome data from centres of excellence showed cancer control rates, urinary continence and potency rates comparable to those of ORP, but with the additional benefit to patients of a minimally invasive approach [5,6].…”

Section: Evolution Of Ralrp From 2000 To 2009mentioning

confidence: 99%