OPEN SURGICAL REVISION OF LAPAROSCOPIC PELVIC LYMPHADENECTOMY FOR STAGING OF PROSTATE-CANCER - THE IMPACT OF LAPAROSCOPIC LEARNING-CURVE

We attempt to clarify the impact of the learning curve on the first 30 laparoscopic pelvic lymphadenectomies performed at our institute. Ope n surgical revision of the area of laparoscopic dissection was perform ed at radical retropubic prostatectomy. The mean number of obturator a nd iliac lymph nodes removed laparoscopically was 8.7 and 8.8 from the right and left sides, respectively. The mean number of residual obtur ator and iliac lymph nodes removed at open operation was 3.2 and 3 fro m the right and left sides, respectively. The amount of residual lymph node tissue after laparoscopic lymphadenectomy progressively decrease d with time, especially after the first 20 cases. A microscopic pelvic lymph node metastasis was found at open operation in patients 6, 14 a nd 15, who had false-negative results at laparoscopy. Due to the learn ing curve effect, the first 30 patients who undergo laparoscopic pelvi c lymphadenectomy should be assessed again by an open operation at rad ical retropubic prostatectomy.