Initial experience with extraperitoneal monopolarless laparoscopic radical prostatectomy in a secondary hospital of Greece

Iason Kyriazis, Dimitrios Dimitriou, Markos Karavitakis, Evangelos Liatsikos, Anastasios Thanos

Abstract


Aim of the study: To report the prospectively collected outcomes
of our initial experience with laparoscopic radical prostatectomy in
a secondary hospital of Greece.
Materials and methods: In total 15 cases with localized prostate cancer
(3x low risk, 5x intermediate risk and 7x high risk) and a mean age of 70
years (range 58-79) were operated during a 9 month period in our department.
All operations were performed by a single laparoscopic surgeon
under the supervision of two senior experienced open surgeons and the
assistance of an assistant experienced in laparoscopic prostatectomy.
Results: No case was converted into open surgery. Mean operating
time (OT) dropped gradually from 5.5 hours in the beginning of our
experience to up to 2 hours with a mean OT of 3.2 hours including 6
cases where a pelvic lymph node dissection was deemed necessary.
Blood loss was minimum in all cases and no transfusion was required.
All but 3 cases (80%) were discharged on the first postoperative day
and catheter was removed 5 days later under cystographic verification
of anastomotic water tightness in the vast majority of cases. Positive
surgical margins (PSMs) were present in 5 patients (33%). Immediate
continence after catheter removal was evident in 53% of our cases and
early continence (continent within 2weeks from catheter removal) in
60%. Out of 10 patients having completed a 3month follow-up, 80%
(8/10) were pad free. Both two incontinent patients still use 1 pad per
day and include one case with immediate continence which started
leaking after salvage radiotherapy initiation. PSA failure (>0.2ng/
dL) at 3 months was evident in 3 (30%) of patients including one
patient operated with a PSA of 136ng/dL and two patients without
PSMs. All these cases were included in the first 6 operated cases and
were scheduled for salvage radiation treatment. At a mean of 56 days
post prostatectomy, potency was restored in 3 patients following a
penile rehabilitation protocol after surgery while none of the rest of
patients requested further treatment for impotency.
Conclusions: In the hands of a well-trained surgical group, perioperative
morbidity of laparoscopic radical prostatectomy during the initial phases
of learning curve is minimum. Early continence outcomes can reach
comparative levels with the high volume center literature after the very
first cases. Initial oncological outcomes were inferior to the published literature
yet they were most likely due to case selection (older patients with
adverse pathology) than due to limitations of the operative technique.


Keywords


Prostate Cancer;Laparoscopic;Radical Prostatectomy;Learning curve

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DOI: http://dx.doi.org/10.19264/hj.v30i3.243