Laparoscopic radical prostatectomy: Preliminary results

Background: Retropubic and perineal radical prostatectomy are used for cura tive treatment of localized prostate cancer. More complex urological proced ures are now being done with laparoscopy. We present our initial results of transperitoneal laparoscopic radical prostatectomy. Materials and Methods: Twenty laparoscopic radical prostatectomies were per formed between May 1998 and May 1999. The mean age at the time of surgery w as 64.2 years. There were 14 stage T1c, 5 stage T2a and 1 stage T2b tumors. The preoperative PSA was 9.3 ng/ml (normal <4 ng/ml). The Gleason score fo r positive specimens in 6 random echo-guided endorectal biopsies was 5.7. F our trocars were used. Insufflation pressure was 15 mmHg. The seminal vesic les were first dissected. The prostate was dissected free from the anterior face of the rectum to the prostate apex. Then the peritoneum was incised t o find the apex of the prostate. The puboprostatic ligaments were isolated and cut, and the dorsal Vein complex was ligated and cut to expose the uret hra. The bladder neck was opened and dissected free from the prostate. The lateral pedicles were coagulated before sectioning the urethra. The radical prostatectomy specimen was left along the sigmoid colon, the bladder neck was reconstructed, and a urethrovesical anastomosis was performed with 6 in terrupted sutures. The prostatectomy specimen was removed intact in a sack by enlarging the umbilical trocar port. All the prostatectomy specimens wer e processed according to the Standford protocol. Prostate weight, tumor wei ght, the Gleason score, and the tumor status of the capsule, seminal vesicl es, lymph nodes and surgical margins were studied. Results: The operating time was 385 min. Two patients were transfused. The mean hospital stay was 7.8 days. The Foley catheter was removed 10.7 days a fter the operation. Specimen weight was 61 (28-126) g, the Gleason score wa s 5.9, and tumor volume was 1.4 ml. There were 18 stage pT2, 1 stage pTa (c apsular effraction) and 1 stage pT3b (seminal vesicle invasion) tumors. The re were four positive surgical margins (2 at the apex and 2 at the bladder neck). All the patients had a postoperative PSA level <0.1 ng/ml at 1 month . The first patient had urethrovesical anastomotic leakage, and required Fo ley catheterization for 21 days. There was 1 colostomy for rectal injury an d 1 urinoma because of urethrovesical anastomotic leakage that required an open surgical procedure. One month after surgery, 15 (75%) patients were fu lly continent. Six patients had erections, and 5 stated having sexual inter course. Conclusion: These preliminary results show that radical prostatectomy can b e performed laparoscopically. Laparoscopy offered excellent vision of all t he anatomical structures of the pelvis, permitting precise dissection. Long -term follow-up and further studies are required to confirm and improve the se results. Copyright (C) 2000 S. Karger AG, Basel.