COMBINED LAPAROSCOPIC PELVIC LYMPH-NODE DISSECTION AND MODIFIED BELT RADICAL PERINEAL PROSTATECTOMY FOR LOCALIZED PROSTATIC ADENOCARCINOMA

Objective. Despite many known advantages, the radical perineal prostat ectomy (RPP) had fallen out of favor because of the need for a second incision for the regional lymph node dissection. Laparoscopic lymphade nectomy, however, provides an accurate and minimally invasive alternat ive to open lymph node dissection. Herein are reported the practical a dvantages of combining laparoscopic lymph node dissection (LPLND) with RPP. Methods. Forty-nine patients with clinically localized carcinoma of the prostate were considered candidates for RPP using a modified B elt technique. Thirty-five patients underwent attempted LPLND and 31 o f these patients subsequently underwent RPP; 14 patients underwent RPP alone. Variables examined included total operative time, transfusion requirement, length of hospital stay, continence, and potency. Results . The mean operative time for LPLND combined with RPP in 31 patients, including time for repositioning, was 4.5 hours (range 3.0 to 7.0 hour s). Only 26 percent of the patients who underwent the combined approac h required blood transfusions of which 75 percent received autologous units. Mean length of stay was six days, and laparoscopy did not contr ibute significantly to postoperative morbidity. Eighty-four percent of the patients are completely continent. Of 27 potent patients who unde rwent nerve-sparing surgery, 22 percent are potent and an additional 3 0 percent are sexually active with intracavernous pharmacotherapy. The re were no perioperative deaths, 2 major complications, and 5 minor co mplications. Conclusions. Laparoscopic techniques now permit the urolo gist to utilize the perineal approach, and its many advantages, to rad ical prostatic extirpation without the need for a formal abdominal inc ision. The minimal blood loss and low morbidity associated with laparo scopic pelvic lymphadenectomy combined with the radical perineal prost atectomy make this procedure an attractive alternative to the open ret ropubic approach for clinically localized prostatic adenocarcinoma.