Laparoscopic radical prostatectomy: Technical and early oncological assessment of 40 operations

Objective: To evaluate the technical feasibility, oncological efficacy and intraoperative and postoperative morbidity of laparoscopic radical prostate ctomy. Method: We describe an original technique of laparoscopic radical pr ostatectomy performed in 40 patients between 26th January and 12th October, 1998. Results: Radical prostatectomy was performed entirely by laparoscopy in 35 patients (87.5%) and only one conversion was performed in the last 2 6 patients (4%). Pelvic lymphadenectomy was performed in the light of preop erative staging data in 14 patients (35%). The median total operating time was 270 min. The only major complication was a rectal injury (patient 8), s utured laparoscopically with an uneventful postoperative course. Postoperat ive vesical catheterization lasted an average of 7.65 days. Seven patients were transfused (17.5%) with an average of 2.8 units of packed cells (range : 2-3). The reduction of postoperative pain is an element allowing for a ra pid discharge of the patients by the 3rd postoperative day. The oncological results were as follows: 36 patients had a pT2 tumor (90%); prostate tumor was staged as N0 in 14 cases and NX in 26 cases. Surgical margins were neg ative in 33 patients (82.5%). Two patients had a doubtful resection margin (1 at the apex and 1 at the bladder neck) and 5 patients had positive margi ns. The last PSA level was undetectable (<0.1 ng/ml) in 26 (89.7%) of the 2 9 patients in whom PSA level was available more than 1 month a Rer the oper ation. Functional results are not yet available and will be published later . Conclusions: Radical prostatectomy is an operation which can be routinely performed by laparoscopy by a team experienced with this technique. Operat ive and postoperative morbidity was low. Short-term oncological data appear identical to the results of conventional retropubic surgery. The improveme nt of operative visibility was considerable allowing a much more precise di ssection. The laparoscopic approach appears to represent a technical improv ement of the radical prostatectomy if the functional results of this operat ion improve parallel to the quality of dissection. A long-term follow-up is needed to define definitively the place of this new approach to radical pr ostatectomy.