RADICAL LAPAROSCOPIC PROSTATECTOMY - EARLY RESULTS IN 28 CASES

OBJECTIVE: Evaluate the technical feasibility of laparoscopic radical prostatectomy, its carcinological efficacy and per- and postoperative moibidity. PATIENTS AND METHODS: We performed radical prostatectomy us ing a new laparoscopic technique in 28 patients between February 1 and August 31, 1998. RESULTS: Radical prostatectomy was achieved totally by a laparascopic approach in 24 patients (86%). No conversion was req uired in the last 14 patients. In 9 patients (32%) ilio-obturator node resection was also performed as indicated by preoperative extension w ork-up. Mean operative time was 270 minutes. The only major complicati on was one rectal wound (patient n degrees 8) which had a benign cours e after suturing under laparoscopy. The bladder catheter was removed a mean 7.7 days after the procedure. Five patients (18%) required trans fusions (mean 2.7 units, range 2-3). Rapid discharge on day 3 was poss ible due to rapid pain relief postoperatively. Tumor classes were pT2 in 26 patients, NO in 9, NX in 17. The surgical border was doubtful at the apex in one case. The last prostate specific antigen assay was be low detectable levels (<0.1 ng/ml) in 16 patients (89%) among the 18 w ith levels know prior to the procedure. Continence was assessable in 2 0 patients after a 1 to 6 month follow-up. Continence was perfect in 1 8 patients and becoming so in 12. Sexual activity was not assessed in this series due to the short follow-up. CONCLUSION: Radical prostatect omy can be reasonably performed as a routine laparoscopic procedure by a well-trained team. The cancerological results in this series were e quivalent to those with conventional retropubic surgery and morbidity was very low. Improved operative vision was considerable, allowing muc h more precise dissection. The laparoscopic technique appears to be an important improvement for radical prostatectomy and should help impro ve functional outcome.