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Abstract
Purpose
Compared with radical retropubic prostatectomy (RRP), laparo-scopic surgery significantly reduces postoperative discomfort, the length of the hospital stay and the length of the convalescent period. However, the procedure of laparoscopic radical prostatectomy (LRP) is difficult to master. Therefore, we considered the surgical technique that is minimally invasive like LRP and it does not require a considerable learning curve and brings good results, like conventional RRP.
Materials and Methods
From January to May 2006 at our institution, we performed LaMRRP on 7 patients who were diagnosed with clinically localized prostate cancer. Under general anesthesia, a 5cm midline incision was made suprapubically and a 10mm trocar is introduced extraperi-toneally at the umbilicus for the camera. The assistant port consisted of a 5mm trocar that was placed for blood suction and for vesicourethral anastomosis. We performed the operation under direct vision through the small window and using a video monitor. The surgical procedures followed the steps employed in conventional RRP.
Results
We successfully performed the operation in all cases without any extension of the incision. The mean patient age is 68.4 years old (range: 59–75). The mean operating time was 320 min (range: 290–360). The mean blood loss was 1,380ml (range: 1,150–1,800). There were no major complications. The postoperative pain was noticeably reduced compared with conventional RRP. The urethral catheter was left in place for 18 days (range: 14–25) in all the patients and postoperative cystography showed no leakage.
Conclusions
We could perform LaMRRP with using enhanced surgical views, and there was no long learning curve and no additional expense. The results of LaMRRP were not significantly different from that of conventional RRP. Therefore, LaMRRP could be a useful method for the treatment of localized prostate cancer.
References
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Fig. 1.
From the top, long blade retractor, Ko's penetrated T retractor, short curved blade retractor (anterior aspect) and short curved blade retractor (lateral aspect).
Fig. 2.
Positioning of retractor and the 0o laparoscope and creating at the a spacious cavity around the target specimen.
Fig. 3.
Vesico-urethral anastomosis. The operator is suturing at the 1 o'clock position of urethra with a laparoscopic needle holder through a 5mm port (arrow: 1 o'clock position of urethra).
Table 1.
Characteristics of the patients who underwent LaMRRP and c RRP
Table 2.
Operative and postoperative characteristics of the LaMRRP and c RRP patients
| LaMRRP (range) | c RRP (range) | |
|---|---|---|
| Mean operative time (min)∗ | 320 (290–360) | 244 (220–320) |
| Mean EBL (ml) | 1,380 (1,150–1,800) | 1,400 (700–2,400) |
| Mean incision length (cm)∗ | 5 | 13.5 (12–15) |
| Mean catheter days | 18 (14–25) | 20 (16–24) |
| Mean admission days | 9.5 (9–11) | 11.4 (8–13) |
| Continence† | 7 (100%) | 8 (80%) |
| Positive surgical margin | 2 (25.5%) | 2 (20%) |
| Pathologic stage | ||
| T2a | 5 | 4 |
| T2b | 1 | 2 |
| T2c | 2 | |
| T3a | 1 | 2 |
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