Initial experience with extraperitoneal laparoscopic radical prostatectomy after 20 procedures by a single surgeon

ObjectiveExtraperitoneal laparoscopic radical prostatectomy (ELRP) has been established as a minimally invasive and viable alternative to the open procedure. Herein, we summarize the initial experience of single surgeon who performed 20 procedures for clinically localized prostate cancer.Materials and MethodsBetween February 2006 and June 2009, 20 patients underwent an ELRP. Demographic data, including age, preoperative prostate-specific antigen (PSA), prostate volume, Gleason score, and ASA score were collected. A five-trocar extraperitoneal technique was used. Surgical parameters, pathological staging, postoperative complications, hospital stay, continence state, and oncological control during follow-up were retrospectively reviewed.ResultsThe mean age was 67.5 (54–81) years. Mean preoperative PSA was 24.6 ± 15.8 ng/mL and prostate volume was 47.8 ± 22.5 (17–92) mL. The mean operative time was 325 ± 58 (220–465) min. Mean blood loss was 450 ± 300 (250–3000) mL. The mean postoperative hospitalization was 10.4 ± 4.9 (5–25) days. The one major complication that occurred was deep-venous thrombosis, and venous filter implantation was applied. In addition, one had anastomosis disruption, and three had bladder neck contracture. All patients had transient stress urinary incontinence but almost 80% were continent 9 months later. Biochemical failure was noted in five patients, and they received adjuvant hormone or radiation therapy. All patients are alive except one who had pelvic lymph node involvement (N1) with bony metastasis; that patient died 34 months postoperatively.ConclusionA major benefit of ELRP compared to the transperitoneal approach is avoiding potential risks of intraperitoneal injury. In addition, it can also isolate urine leakage due to a negligent interrupted suture at anastomosis. From our 5-year short-term follow-up, it provides equal efficacy in tumor control as does a radical prostatectomy. We think that as experience accumulates, better postoperative oncological and functional outcomes are expected.