Laparoscopic radical prostatectomy - The Creteil experience

Objectives. In an effort to reduce the morbidity associated to radical pros tatectomy, we implemented laparoscopic surgery to this advanced ablative an d reconstructive procedure. In our study, we describe our operative techniq ue and assess our results in terms of oncologic cure, continence and potenc y. Methods: 200 patients with clinically localized prostate cancer underwent l aparoscopic radical prostatectomy. 66 of these patients were either referre d, or operated during surgical demonstrations. Thus, complete evaluation is based on a homogenous personal series of 134 patients and was performed by an independent clinical analyst. There were 91 T1 and 43T2. We did not per form pelvic lymph node excision in 78 patients whose PSA was less than 10 n g/ml and the Gleason score of endorectal biopsies was below 7. The surgical procedure recapitulated the steps of traditional retropubic prostatectomy with one basic difference however: the first step of the technique consiste d in a rectoprostatic cleavage, which was done transperitoneally. Except fo r the first 10 patients, the vesicourethral reconstruction was performed ei ther with two hemi-circumferential or a single circumferential running sutu re. Results. All interventions were performed as planned, no conversions were n ecessary, and! only 4 patients required blood transfusion. Operating time d ecreased with growing experience; after the first 20 patients the usual ope rating time was 3.5 h without and 4 h with lymphadenectomy. The surgical co mplication rate was 22.5% in the first 40 patients, and 3.2% in the remaini ng 94 patients. Except for the first 10 patients, the mean hospital stay wa s 6.1 days and bladder catheterization 4.8 days, Median catheterization tim e was 4 days. Histological study of the specimen showed pT2 disease in 101 patients and pT3 in 33 patients, the rate of positive margins was 16.8 and 48.8%, respectively. At 1 year, overall erection rate (with or without sexu al intercourse) was 56%, the rate of patients without pad was 86.2% during the day and 100% during the night. Conclusions. Laparoscopic environment seems to comply with the oncologic go als of radical prostatectomy. Improved intraoperative visualization and mag nification may provide benefits for the preservation of continence and pote ncy by allowing a more precise dissection and vesicourethral reconstruction . Despite longer operative times and the steep learning curve this new tech nique is currently proliferating due to expectations of decreased postopera tive morbidity and better quality of life. Copyright (C) 2001 S. Karger AG, Basel.