Radical prostatectomy: evolution of surgical technique from the laparoscopic point of view

Abstract

Purpose: To review the literature and present a current picture of the evolution in radical prostatectomy from the laparoscopic point of view. Materials and Methods:We conducted an extensive Medline literature search. Articles obtained regarding laparoscopic radical prostatectomy (LRP) and our experience at Institut Montsouris were used for reassessing anatomical and technical issues in radical prostatectomy. Results: LRP nuances were reassessed by surgical teams in order to verify possible weaknesses in their performance. Our basic approach was to carefully study the anatomy and pioneer open surgery descriptions in order to standardized and master a technique. The learning curve is presented in terms of an objective evaluation of outcomes for cancer control and functional results. In terms of technique-outcomes, there are several key elements in radical prostatectomy, such as dorsal vein control-apex exposure and nerve sparing with particular implications in oncological and functional results. Major variations among the surgical teams' performance and follow-up prevented objective comparisons in radical prostatectomy. The remarkable evolution of LRP needs to be supported by comprehensive results. Conclusions: Radical prostatectomy is a complex surgical operation with difficult objectives. Surgical technique should be standardized in order to allow an adequate and reliable performance in all settings, keeping in mind that cancer control remains the primary objective. Reassessing anatomy and a return to basics in surgical technique is the means to improve outcomes and overcome the difficult task of the learning curve, especially in minimally access urological surgery.

Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial

“…In recent years, a general attitude toward a less radical and nerve-sparing treatment was proposed with the triple objectives of preserving function, reducing morbidity, and maintaining cure rates while improving the quality of life [25,[28][29][30][31][58][59][60].…”

“…The pelvic sympathetic and parasympathetic neural pathway (superior hypogastric plexus, left and right hypogastric nerves, left and right pelvic splanchnic nerves, right and left hypogastric plexus, or pelvic plexus) exerts neurogenic control of rectal, bladder, and sexual functions (vaginal lubrication and swelling). To preserve these functions, several nerve-sparing procedures have been successfully adopted in oncologic radical pelvic surgery [25][26][27][28][29][30][31][32]. These procedures have proven to be effective in preserving neurologic pelvic functions with similar disease-free intervals and clinical outcomes [27,33,34].…”

The application of a blunt‐tip needle to suture the dorsal venous complex in robot‐assisted laparoscopic radical prostatectomy

“…Although some urologists have recently preferred selective suturing of the DVC after transection, many surgeons still cling to the traditional approach . Proper handling of the DVC may provide a clear surgical field, which is crucial to complete tumor resection as well as to the protection of the external urethral sphincter …”

Description of the Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique

“…The development and improvement of surgical technique achieved by LRP and RARP may not be entirely due to their technological advances. The enhanced vision associated with a convenient sitting position, wider operative field, and ability for more precise movements are advantages of robotic-assisted surgery, and are part of evolution in surgical techniques toward better visualization of pelvic anatomical structures such as the cavernous nerve fibers within the periprostatic tissue, seminal vesicles, prostatic pedicle, apex, and urethra [1,2,5,[15][16][17][18]. This advancement has allowed for the development of a new method to perform an anterograde anatomical dissection technique that is more precise and less invasive than the classical open RRP described in 1983 by Walsh et al [2,5,6,[9][10][11]15,17,18].…”

“…The refinement of surgical technique and the incorporation of new technologies such as robotics have contributed to better oncological and functional outcomes, as well as leading to the classification of this procedure as minimally invasive surgery [1,2]. The laparoscopic prostatectomy technique was first developed in 1997 by Shuessler et al [3] and improved over time.…”