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

Abstract

Extraperitoneal laparoscopic radical prostatectomy experience in 310 patientsBackground: Laparoscopic prostatectomy is one of the standard treatments for localized prostate cancer. Aim: To report our experience with extraperitoneal laparoscopic radical prostatectomy (ELRP). Material and Methods: Prospective recording of 310 ELRP performed between 2001 and 2005. The series was divided chronologically in three groups. Group 1 was formed by the first 100 operated patients and groups 2 and 3 by subsequent series of 100 subjects, to show the learning curve. ELRP was performed using an anterograde technique, placing five trocars. Results: Median age of patients was 62 years. No differences in the clinical data of patients in the different groups were observed. Median prostate specific antigen was 13.3 ng/ml. One hundred eighty patients (60%) had a Gleason score of 2 to 6: 80 patients (25%) had a score of 7 and 50 patients(15%) had a score of 8 to 10. Two hundred fourteen patients (69%) were in clinical stage T1c, 62 patients (20%) were in stage T2a and 34 patients (11%) were in stage T2b. Surgical times were 185, 139 and 134 min in groups 1,2 and 3 respectively (p < 0.05). Blood transfusions were required in 20, 22 and 3% of patients in groups 1, 2 and 3 respectively. The figures for blood loss were 624, 451 and 268 cc, respectively. Positive surgical margins were observed in 24, 9 and 12% of patients in groups 1, 2 and 3 respectively. Rectal injuries occurred in 9, 2 and none patient of groups 1, 2 and 3 respectively. Urinary fistula occurred in 4, 1 and no patient of groups 1, 2 and 3 respectively. Late complications such as bladder neck stricture and incontinence decreased in consecutive groups. Conclusions: ELRP is a safe and effective technique for the treatment of localized prostate cancer, but it has a learning curve to reduce the incidence of complications.

Cirugía laparoscópica de la fístula vesico-vaginal: resultados de una experiencia multi-institucional

“…Sin embargo, la necesidad de una sutura intracorpórea se presenta quizás como un importante obstáculo para desarrollar este abordaje. En nuestro caso, la experiencia en prostatectomía radical laparoscópica ha reducido nuestra curva de aprendizaje permitiendo incorporar el abordaje laparoscópico a nuestro arsenal terapéutico 11 . Recientemente publicamos nuestra experiencia en la reparación laparoscópica de FVV en 8 casos demostrando ser un abordaje factible y seguro que puede reproducir los pasos de la cirugía convencional 5 .…”

Prostatectomía radical asistida por robot da Vinci: experiencia inicial en 50 casos consecutivos

“…En esta publicación demostramos estadísticamente que la curva de aprendizaje es francamente menor comparado con la laparoscópica, siendo de 40 procedimientos para la PRR. Recordamos que era de 100 para la PR laparoscópica, tal como fue demostrado por Castillo y cols 20,21 . Como conclusión, el abordaje robótico de la PR proporcionaría una recuperación de la continencia precozmente en comparación con los otros abordajes y, como demostramos estadísticamente, la curva de aprendizaje es menor comparado con el abordaje laparoscópico.…”