Laparoscopic radical prostatectomy: The montsouris experience

Purpose: We evaluate our experience with laparoscopic radical prostatectomy . Materials and Methods: Between February 1, 1998 and May 1, 1999, 120 consec utive patients underwent laparoscopic radical prostatectomy. Morbidity of t he first 40 (group 1), next 40 (group 2) and last 40 (group 3) procedures w as compared. Oncological data were assessed by pathological examination and postoperative prostate specific antigen (PSA). Functional results were ass essed by a self-administered questionnaire for the first 60 patients and po tency was assessed in the last 40. Results: Mean operating time plus or minus standard deviation was 239 +/- 5 9 minutes (range 150 to 450) for the series, and 282, 247 and 231, respecti vely, for groups 1, 2 and 3. Surgical conversion was necessary in 7 cases ( 5.8%) overall, including 10% (4) in group 1, 7.5% (3) in group 2 and 0% in group 3. Mean intraoperative bleeding was 402 +/- 293 mi. (range 50 to 1,50 0) in the series, and 534, 517 and 277, respectively, for groups 1, 2 and 3 . The transfusion rate was 10% overall, and 15%, 12.5% and 2.5%, respective ly, in groups 1, 2 and 3. The reoperation rate was 1.7%. Mean postoperative bladder catheterization time was 6.6 +/- 2.4 days. The positive and questi onable surgical margin rate was 15%. Pathological tumor stage was pT2a in 4 specimens (11%), pT2b in 11 (16%), pT3a in 0 and pT3b in 3 (50%) with posi tive surgical margins. PSA assays were available in 94 patients with a mean postoperative followup of 2.2 months (range 1 to 12). Serum PSA was 0.1 ng ./ml. or less in 89 men (94.7%). The continence rate at 6 months postoperat ively was 72% among the first 60 patients. Of 20 group 3 patients who were sexually active preoperatively 9 (45%) reported postoperative spontaneous e rections. The overall cost of retropubic radical prostatectomy was about $1 ,237 more than that for laparoscopy. Conclusions: Laparoscopic radical prostatectomy is feasible and perioperati ve morbidity is low. Based on our postoperative followup, oncological resul ts are identical to those of conventional surgery and functional results ar e encouraging.