A safe laparoscopic model to approach prostate cancer: a single center experience

Michele Amenta1, Pietro Scialpi1
  • 1 P.O. di Portogruaro, U.O.C. Urologia (Portogruaro)

Objective

To assess the safety and the oncological and functional efficacy of a prospective series of extraperitoneal laparoscopic radical prostatectomy (ELRP), to suggest the validity of laparoscopic technique in oncological control and preservation of continence and sexual function, based on data from experience in a single urological center. Our report describes one institution’s experience and the analysis confirms that the efficiency of laparoscopic radical prostatectomy is no longer in question; indeed, the authors report data on the short-term oncologic efficacy.

Materials and Methods

Over one year, 80 patients underwent to a videolaparoscopic radical prostatectomy for prostate cancer. All the procedures were carried out by the same operator. An extraperitoneal technique (ELRP) was used in 72 patients, a transperitoneal descending technique in 2 patients, due to previous abdominal surgery. Pelvic lymph node dissection (PLND) was carried out only in selected case (12 patients) belonging to intermediate/high risk group (2-4) according to Grade Group classification (Pierorazio et al).

Results

There were no conversions to open surgery. The mean (SD) operative duration was 127 (28,1) min (range 60-195 mL) , the blood loss was 381 (276,62) mL, the hospital stay was 7.1 (2.0) days, and the duration of catheterisation 6.1 (1.5) days. Collectively, 26,25% (21/80) of patients had positive surgical margins. Mean PSA nadir at one month was 0,075 ng/ml.

Discussions

With the advent of robotic surgery, it seemed that laparoscopic technique was set aside and overcome, but several considerations should be made in favor of laparoscopy, especially as far as its economic and clinical benefits are concerned. First, the robotic procedure is expensive. Leonardo da Vinci devices are only available in some centers, so the waiting list for intervention is in many cases too much long. Secondly, the alternatives to robotics are open surgery and laparoscopy. Open surgery is now an unsafe technique, especially if there are difficulties in some cases of accurate control of the haemostasis and to allow nerve sparing approach, when required. In these terms the benefit of laparoscopy is in the best vision and vascular and nervous control.

Conclusion

Laparoscopic technique is technically safe and not to much difficult nor impracticable, however with a longer learning curve than the open and robotic techniques. The benefits are to be found in terms of short-term oncological outcomes as well as continence and sexual power in patients undergoing NS technique. We highlight the feasibility of the technique and the benefits of cost reduction

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