Laparoscopic Radical Prostatectomy: The Montsouris Experience

Guillonneau, Bertrand; Vallancien, Guy

doi:10.1016/s0022-5347(05)67890-1

Cited by 440 publications

(269 citation statements)

References 12 publications

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“…Drains were removed in all patients before discharge. Catheters were removed after a mean (range) of 6.1 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) days, all with no previous cystogram. Twenty-nine patients had a modified pelvic lymphadenectomy.…”

Section: Resultsmentioning

confidence: 99%

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Laparoscopic radical prostatectomy: oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

Gao¹,

Zhou²,

Li³

et al. 2009

Asian J Androl

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In this study we evaluate the oncological and functional results of the largest cohort of patients in China treated by laparoscopic radical prostatectomy (LRP) and with at least 3 years of follow-up. 126 inconsecutive patients (range 56-78 years, median 62.5) who had an LRP were retrospectively analyzed. The mean prostate specific antigen level and Gleason score was 13.4 ng mL -1 and 6.4, respectively. Twenty-seven patients had unilateral or bilateral nerve preservation and 29 had pelvic lymphadenectomy. Multivariate analysis was used to adjust for differences in clinical and pathological features when comparing the risk for biochemical progression-free survival (bPFS). Urinary continence was assessed by incontinence questionnaire and erectile function by the Sexual Health Inventory for Men score. The mean operative duration was 250 min and blood loss 354 mL. Five patients received blood transfusion and nine had complications, including rectal injury (two), ureteral injury (one), active bleeding (one), bladder neck stenosis (two), paralytic ileus (one), subcutaneous hematoma (one) and port-site hernia (one). The overall positive surgical margin rate was 20.6% and correlated with pathological stage and Gleason score respectively (P = 0.03, P < 0.001 respectively). All patients had ≥ 3 years of follow-up (range 3-6.75 years, mean 4.6, median 4.75). At 3 years of follow-up, the overall survival rate was 100% and the bPFS was 81.0% in all patients; 124 patients (98.4%) were continent; 22 of 27 patients (81.5%) who underwent nerve preservation retained erectile function. Our series confirms that LRP is an effective, safe and precise technique at Chinese institution.

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Section: Resultsmentioning

confidence: 99%

“…LRP was performed using the Montsouris technique, with some modifications by us [10][11][12][13]. In brief, after the puboprostatic space is developed, the bilateral endopelvic fascia of the prostate is dissected longitudinally toward the apex and puboprostatic ligament section.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Laparoscopic radical prostatectomy: oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

Gao¹,

Zhou²,

Li³

et al. 2009

Asian J Androl

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show abstract

“…The incidence of positive surgical margins is very similar for each technique but the location of the margins is dependent upon the approach. 23,51,52 The apex is the most common site for positive margins in the retropubic and laparoscopic approaches, whilst the anterior prostate is the most common site when the perineal approach is employed. 7,8,23,51 -54 Table 1 shows the incidence and site of positive margins.…”

Section: Surgical Techniquementioning

confidence: 99%

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Bott¹,

Kirby

2002

Prostate Cancer Prostatic Dis

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Positive surgical margins after radical prostatectomy lead to an increased risk of progression and reduced disease free survival. Earlier detection of prostate cancer, appropriate patient selection and improved operative techniques can reduce the incidence of positive margins, though the risk can not be eliminated as preoperative staging techniques are not sufficiently sensitive. Nerve sparing and bladder neck sparing do not adversely affect margin status in appropriately selected men. Once positive margins have been diagnosed the optimal management and the timing of treatment remains controversial. Adjuvant radiotherapy or salvage radiotherapy in men with a low PSA may improve local control and PSA free survival in some individuals, a survival benefit has not yet been established.

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“…LRP was performed by the intraperitoneal approach reported by Guillonneau and Vallancien as the Montsouris technique (Guillonneau and Vallancien, 2000). In 2-port RP, as we previously described (Nakane et al, 2013), a multichannel port was inserted extraperitoneally through a 2.5-cm lower umbilical "U" incision ( Figure 1A).…”

Section: Methodsmentioning

confidence: 99%

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

Akita

Nakane²,

Ando³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy ( .6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

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Laparoscopic Radical Prostatectomy: The Montsouris Experience

Abstract: Laparoscopic radical prostatectomy is feasible and perioperative morbidity is low. Based on our postoperative followup, oncological results are identical to those of conventional surgery and functional results are encouraging.

Cited by 440 publications

References 12 publications

Laparoscopic radical prostatectomy: oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

Laparoscopic radical prostatectomy: oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

Avoidance and management of positive surgical margins before, during and after radical prostatectomy

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

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