Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie · 2002
[Exclusively extraperitoneal laparoscopic radical prostatectomy].
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Adjiman Stéphane, Pansard Jean-Louis
Аннотация
OBJECTIVE: To evaluate the technical feasibility, efficacy, and intraoperative and postoperative morbidity of exclusively extraperitoneal laparoscopic radical prostatectomy (RP).
MATERIAL AND METHODS: From August 2000 to December 2001, 35 patients have had an extraperitoneal laparoscopic radical prostatectomy. The operation comprised an exclusively extraperitoneal 6 cm mini-laparotomy with the use of a camera and laparoscopic instruments. RP is performed via an anterograde approach, starting with release of the bladder neck. 35 patients (pts) were operated from 1st August 2000 to 1st December 2001.
RESULTS: RP was performed via this approach in every case without the need for conversion or enlargement of the incision. The mean operating time was 135 min. No intraoperative complications were observed. Mean blood loss was 210 cc (< 100-350 ml). No patient required transfusion. Discharge was possible on the 5th day in 22 pts the 6th day in 10 pts and the 7th day in 3 pts. Oral feeding was resumed on D1. The bladder catheter was left in place for an average of 4.5 days. Oncological Results: 5 pts presented capsular effraction (PT3--negative fixed margin), 1 pt presented a positive margin at the apex (perineural infiltration). Follow-up is more than three months for all patients. PSA is < 0.1 in 34 of the 35 pts. Continence: at one month, 29 out of 35 pts used 0 to 1 protections/day, at the 3rd month, 33/35 no longer used any protection. Only 2 out of 35 pts used protection beyond 4 months during intense physical efforts.
CONCLUSION: Radical prostatectomy can be performed satisfactorily by this technique which combines the advantages of the two surgical procedures (laparoscopic and open). The operating time is slightly longer than for conventional surgery. The technique appears to be perfectly reproducible, with a rapid learning curve. Atraumatic dissection of the prostatic apex appears to give satisfactory results in terms of urinary continence and postoperative pain is minimal allowing rapid mobilization of the patient.
MATERIAL AND METHODS: From August 2000 to December 2001, 35 patients have had an extraperitoneal laparoscopic radical prostatectomy. The operation comprised an exclusively extraperitoneal 6 cm mini-laparotomy with the use of a camera and laparoscopic instruments. RP is performed via an anterograde approach, starting with release of the bladder neck. 35 patients (pts) were operated from 1st August 2000 to 1st December 2001.
RESULTS: RP was performed via this approach in every case without the need for conversion or enlargement of the incision. The mean operating time was 135 min. No intraoperative complications were observed. Mean blood loss was 210 cc (< 100-350 ml). No patient required transfusion. Discharge was possible on the 5th day in 22 pts the 6th day in 10 pts and the 7th day in 3 pts. Oral feeding was resumed on D1. The bladder catheter was left in place for an average of 4.5 days. Oncological Results: 5 pts presented capsular effraction (PT3--negative fixed margin), 1 pt presented a positive margin at the apex (perineural infiltration). Follow-up is more than three months for all patients. PSA is < 0.1 in 34 of the 35 pts. Continence: at one month, 29 out of 35 pts used 0 to 1 protections/day, at the 3rd month, 33/35 no longer used any protection. Only 2 out of 35 pts used protection beyond 4 months during intense physical efforts.
CONCLUSION: Radical prostatectomy can be performed satisfactorily by this technique which combines the advantages of the two surgical procedures (laparoscopic and open). The operating time is slightly longer than for conventional surgery. The technique appears to be perfectly reproducible, with a rapid learning curve. Atraumatic dissection of the prostatic apex appears to give satisfactory results in terms of urinary continence and postoperative pain is minimal allowing rapid mobilization of the patient.