Laparoscopic radical prostatectomy: Initial experience and preliminary assessment after 65 operations

BACKGROUND. Our purpose was to evaluate the technical feasibility, oncologi cal efficacy, and intraoperative and postoperative morbidity of laparoscopi c radical prostatectomy. METHODS. We describe an original technique of laparoscopic radical prostate ctomy per formed in 65 successive patients during 11 months. RESULTS. Radical prostatectomy was performed entirely by laparoscopy in 59 patients (91%). The median operating time was 265 min, including times for lymphadenectomy performed in 33% of patients. Preoperative complications in cluded one rectal injury, sutured laparoscopically with an uneventful posto perative course, and one epigastric artery injury which needed secondary op en procedure. The transfusion rate was 15.4% (10 patients). Median postoper ative vesical catheterization lasted 7 days. The reduction of: postoperativ e pain allowed rapid discharge of patients, by the fourth postoperative day in 60% of consenting patients. As regards oncological results, resection m argins were negative in 57 patients (87.7%). The last prostate-specific ant igen (PSA) assay was undetectable (<0.1 ng/ml) in 85.7% of the 42 patients in whom PSA was available more than 1 month after the operation. CONCLUSIONS. Radical prostatectomy can be routinely performed by laparoscop y by an experienced team. Short-term oncological data were identical to the results of conventional retropubic surgery, and morbidity was low. The lap aroscopic approach could constitute in the future a technical improvement o ver radical prostatectomy if long-term oncological results are confirmed an d if improvement of intraoperative vision improves the functional results o f this operation. (C) 1999 Wiley-Liss, Inc.