Korean J Urol.  2006 Dec;47(12):1278-1283. 10.4111/kju.2006.47.12.1278.

Extraperitoneal Laparoscopic Radical Prostatectomy: Initial Experience

• Lee CY
• Lee W
• Lee JZ

• KMID: 2139771
• DOI: http://doi.org/10.4111/kju.2006.47.12.1278

Abstract

PURPOSE
To present the short-term results of an extraperitoneal laparoscopic radical prostatectomy technique.
MATERIALS AND METHODS
18 patients underwent a laparoscopic radical prostatectomy for clinical stages ranging from cT2a to cT3b, as found on MR prostate imaging.
RESULTS
Our extraperitoneal laparoscopic radical prostatectomy procedure was technically successful in all 18 patients. The mean age of the patients was 65.3 years. The mean surgical time was 421 minutes. The Foley catheter was able to be removed on postoperative days 10, 14 and 20 from 7, 5 and 3 patients, respectively, and from 1 on each of the 23, 30 and 34 postoperative days. The final pathological results were 2, 6, 5, and 5 stages pT2a, pT2b, pT3a and pT3b, respectively. There was a positive surgical margin in 8 patients (44.4%).
CONCLUSIONS
Our initial series of extraperitoneal laparoscopic radical prostatectomies are presented. Using an extraperitoneal approach, avoiding the peritoneal cavity, can minimize the chances of the bowel coming into contact with electrocautery, and the associated potential sequelae. The extraperitoneal laparoscopic radical prostatectomy procedure is developmental; therefore, long-term data are currently unavailable. Nevertheless, this technique could potentially be an attractive addition to the available radical prostatectomy procedures.

Keyword

Extraperitoneal; Prostatectomy; Laparoscopy

MeSH Terms

Catheters
Electrocoagulation
Humans
Laparoscopy
Operative Time
Peritoneal Cavity
Prostate
Prostatectomy*

Figure

• 

  Fig. 1 Positioning of patient, operator and assistants.

• 

  Fig. 2 Home made ballooning catheter.

• 

  Fig. 3 Dissection of the preperitoneal space by balloon trocar insufflation.

• 

  Fig. 4 Placement of the 5 ports for the trocar in laparoscopic radical prostatectomy.

• 

  Fig. 5 Operative times.

• 

  Fig. 6 Foley catheterization and hospital stay.

Reference

1. Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol. 1999. 162:433–438.

2. Vallancien F, Cathelineau X, Baumert H, Doublet JD, Guillonneau B. Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center. J Urol. 2002. 168:23–26.

3. Sayad P, Ferzli G. The extraperitoneal approach and its utility. Surg Endosc. 1999. 13:1168–1169.

4. Raboy A, Ferxli G, Albert P. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology. 1997. 50:849–853.

5. Bollens R, Vanden BM, Roumeguere T, Damoun A, Ekane S, Hoffmann P, et al. Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol. 2001. 40:65–69.

6. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003. 61:699–702.

7. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997. 50:854–857.

8. Swindle P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N, et al. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol. 2005. 174:903–907.

9. Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol. 2002. 167:51–56.

10. Eden CG, King D, Kooiman GG, Adams TH, Sullivan ME, Vass JA. Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: Dose the approach matter? J Urol. 2004. 172:2218–2223.

11. Cathelineau X, Cahill D, Widmer H, Rozet F, Baumert H, Vallancien G. Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge. J Urol. 2004. 171:714–716.