Early experience of laparoscope assisted radical retropubic prostatectomy

Abstract

Purpose: A laparoscopic radical prostatectomy (LRP) is a less invasive alternative to a conventional radical prostatectomy. However, the learning curve for a LRP is steep; therefore, becoming skilled at the procedure is difficult. Herein, our experience of laparoscope assisted radical retropubic prostatectomy (LARRP) is reported. Materials and Methods: LARRP was performed on 16 patients with clinically organ confined prostate cancer. The mean age and serum prostate-specific antigen (PSA) of the patients were 63 ± 5.7 years (51-70) and 20.01 ± 24.8ng/ml (3.45-97.50), respectively. A longitudinal skin incision was made from the symphysis pubis to midway of the umbilicus. The incision was retracted with a self-retractor, without port placement and gas insufflation. The laparoscope was directly inserted into the wound, with modified bilateral pelvic lymph node dissection, prostatectomy and vesicourethral anastomosis performed under laparoscopic monitoring, using both open and laparoscopic instruments in the same order as for open surgery. Results: The mean operative time was 282±45.7 minutes (200-375), including the time required for the modified bilateral pelvic lymphadenectomy. The mean estimated blood loss and specimen weight were 2,500±1,247ml (500-5,000) and 53±19.0gm (20-98), respectively. The surgical margins and lymph nodes were positive in 3 (19%) and 2 patients (13%), respectively. The mean number of dissected lymph node and incision length were 12±7.5 (4-31) and 11±3.2cm (6-15), respectively. Gradual recovery of continence occurred in 13 (93%) for 1 years after the operation. Conclusions: LARRP is a feasible and less invasive alternative to conventional RRP, which is also devoid of the steep learning curve associated with a LRP. LARRP may be a bridge between an open RRP and a pure LRP. With the increase in the number of cases, LARRP may prove to be an effective treatment option for localized prostate cancer.