LAPAROSCOPIC VS OPEN LYMPH-NODE DISSECTIO N IN PATIENTS WITH PROSTATIC-CARCINOMA - COMPARATIVE METHODOLOGY

Bilateral laparoscopic pelvic lymph node dissection was performed in 2 7 consecutive patients with stage B prostatic carcinoma. The first 5 o perations (learning phase) were compared with the next 22 procedures a nd with a group of 20 patients who had undergone conventional open lym phadenectomy previously. Retropubic radical prostatectomy was done in 22 patients with negative nodes. All residual lymphatic tissue was rem oved. During the learning phase the average operating time was 3 h 40 min. The mean number of laparoscopically removed nodes was 5.8 on both sides. At open operation we found 1.5 residual nodes on the right sid e and 5.3 residual nodes on the left. In one case one of the residual nodes was positive for tumor. Operating time in the next 22 patients w as 2 h 20 min. The number of nodes removed laparoscopically was 8.3 on the right and 7.0 on the left. Residual nodes were found in only 3 pa tients. None of these nodes was positive for tumor. In both groups the number of nodes removed was greater than in the group of patients who underwent open lymphadenectomy. In one of the first 5 patients immedi ate open surgery was required because of bleeding. In 1 patient's node s evidence of Hodgkin disease was found. This was the only patient to develop a lymphatic fistula. There were no lymphoceles. We feel that l aparoscopic pelvic lymphadenectomy has a definite learning curve but i s a safe staging procedure for prostatic cancer with results equivalen t to those of the open operation.