Laparoscopic radical prostatectomy: The lessons learned

Purpose: To evaluate the operative, oncologic, and functional results of la paroscopic radical prostatectomy based on an initial series of 350 patients . Patients and Methods: Between January 1998 and May 2000, 350 consecutive pa tients underwent laparoscopic radical prostatectomy according to our techni que, The study of operative morbidity was based on all intraoperative and p ostoperative complications. The oncologic assessment was based on clinical, laboratory, and intraoperative acid postoperative pathological data. Posto perative functional results were assessed by the ICS-male self-administered questionnaire. Results: No deaths were observed in this series. Conversion was required in seven cases, exclusively among the first 70 patients. The mean operating t ime was 217 +/- 59 minutes, including the lymphadenectomy phase that was co nsidered necessary in 21.4% of patients, and 195 +/- 56 minutes for the mos t recent 200 patients. The mean intraoperative blood loss was 354 +/- 250 m t. The overall transfusion rate was 5.7% and 2.8% in the last 250 patients. Intraoperative complications were reported in 14 patients (4%), and the re operation rate was 3.7%. The mean postoperative bladder catheterization tim e was 5.8 +/- 3.3 days, and the catheter could be removed before the 5th da y in 41% of patients. The mean hospital stay was 6 +/- 3.9 postoperative da ys (range 2-33 days). By pathologic stage, the positive surgical margin rat e was 3.6% for pT(2a) specimens (3 patients), 14% for PT2b specimens (29 pa tients), 33% for pT(3a) specimens (12 patients), and 43.5% for PT3b specime ns (10 patients). In the first 75 patients with pT(2)N(0)/N-x negative-marg in specimens and a follow-up of > 12 months, the PSA concentrations was <0. 2 ng/mL in 92% of patients. The continence rate (no protection necessary ei ther during the day or at night) among the first 133 patients was 85.5% and the postoperative erection rate was 59% among 22 selected consecutive pati ents. Conclusions: This study confirms the value, in our experience, of the lapar oscopic approach to radical prostatectomy, which allows satisfactory cancer control associated with low perioperative morbidity and encouraging functi onal results in terms both of continence and erectile function.