Laparoscopic radical prostatectomy: Preliminary results

Objectives. To evaluate our preliminary experience with laparoscopic radica l prostatectomy. The indications for laparoscopy are currently being extend ed to complex oncologic procedures. Methods. Forty-three men underwent laparoscopic radical prostatectomy. We u sed five trocars. The surgical technique replicates the steps of traditiona l retropubic prostatectomy, except that the rectoprostatic cleavage plane i s developed transperitoneally at the beginning of the procedure. In the fir st 10 patients, we performed the vesicourethral reconstruction with interru pted sutures; in the remaining 33 patients, we performed it with two hemici rcumferential running sutures. the specimen was removed through the umbilic al port site. Results. Once the developmental phase with the first 10 patients was conclu ded, the median operating time was 4.3 hours without pelvic lymphadenectomy , and the median postoperative bladder catheterization was 4 days. Two (4.7 %) of 43 patients underwent transfusion. Twelve patients (27.9%) had positi ve surgical margins; all patients had a postoperative prostate-specific ant igen level of less than 0.1 ng/mL at 1 month. Rectal injury occurred in 1 p atient, requiring colostomy, and 4 patients had urethrovesical anastomotic leakages requiring surgical repair. One month postoperatively, 36 patients (84%) were fully continent (no leakage). Six patients had had erections, an d four stated they had had sexual intercourse. Conclusions. Laparoscopic radical prostatectomy has evolved to a fully stan dardized and reproducible procedure. The short-term oncologic and functiona l efficacy rates are equivalent to those for open surgery. The operating ti me is reasonable once the learning curve is over, and postoperative morbidi ty is diminished. Because of the improved visual accuracy, permitting more precise dissection, this technique has the potential to become an important advancement in urologic surgery. UROLOGY 55: 630-634, 2000. (C) 2000, Else vier Science Inc.