Laparoscopic radical prostatectomy - Technical aspects and experience with125 cases

Purpose.-The laparoscopic access for radical prostatectomy offeres an alter native to the open surgical procedure with less morbidity. We report on our experience with 125 laparoscopic prostatectomies, especially with respect to making the laparoscopic approach a routine procedure and with a view to the oncological and functional results. Material and Methods: From June 1999 to September 2000, we performed 125 la paroscopic prostatectomies. These included only patients with cancer stages T1 orT2. The mean PSA concentration was 10.5 ng/ml. Forty-four percent of the patients had undergone previous abdominal and 19% previous transurethra l surgery. For our laparoscopic prostatectomies we used the descending tech nique. Free-hand laparoscopic suturing and in situ knot-tying technique wer e used for the urethrovesical anastomosis. The mobilized specimens were rem oved in an endobag via a muscle splitting incision. Results. All 125 procedures could be completed successfully. No case requir ed conversion to open surgery. The average operating time was 255 min, the last 40 procedures taking 200 min only. Mean blood loss was 185 ml. Two pat ients (2%) required postoperative blood transfusion. After an, initial lear ning curve, catheter remained in place for an average of 5.5 days, and the average postoperative stay in hospital was 8 days. Intraoperative complicat ions were seen in 5 patients (4%). In 13 patients (10.4%), postoperative co mplications were observed. 86% of the patients are continent 6 months posto peratively. Preservation of the neurovascular bundle and sexual potency is possible. Conclusion: Laparoscopic radical prostatectomy is an ambitious procedure wi th a steep learning curve, especially for the laparoscopic dissecting and s uturing technique. The excellent sight for dissection results in a reduced blood loss and faster convalescence with an overall! lower morbidity. Also with regard to oncological and functional (continence) results the minimall y invasive access is at least equivalent to the open procedure. In our opin ion, laparoscopic prostatectomy will be the future method of choice for rad ical prostatectomy.