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

Chia Cheng Su, Steven K. Huan, Ying Huei Lee, Kun Hung Shen, Wen-Hsiang Chiou

Research output: Contribution to journalArticle

Abstract

Objective: Extraperitoneal 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 Methods: Between 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. Results: The 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. Conclusion: A 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.

Original languageEnglish
Pages (from-to)9-12
Number of pages4
JournalUrological Science
Volume23
Issue number1
DOIs
Publication statusPublished - Mar 2012
Externally publishedYes

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Prostatectomy
Prostate-Specific Antigen
Prostate
Stress Urinary Incontinence
Neoplasm Grading
Contracture
Operative Time
Surgical Instruments
Venous Thrombosis
Sutures
Length of Stay
Prostatic Neoplasms
Urinary Bladder
Hospitalization
Radiotherapy
Lymph Nodes
Demography
Surgeons
Urine
Hormones

Keywords

  • Extraperitoneal laparoscopic radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Initial experience with extraperitoneal laparoscopic radical prostatectomy after 20 procedures by a single surgeon. / Su, Chia Cheng; Huan, Steven K.; Lee, Ying Huei; Shen, Kun Hung; Chiou, Wen-Hsiang.

In: Urological Science, Vol. 23, No. 1, 03.2012, p. 9-12.

Research output: Contribution to journalArticle

Su, Chia Cheng ; Huan, Steven K. ; Lee, Ying Huei ; Shen, Kun Hung ; Chiou, Wen-Hsiang. / Initial experience with extraperitoneal laparoscopic radical prostatectomy after 20 procedures by a single surgeon. In: Urological Science. 2012 ; Vol. 23, No. 1. pp. 9-12.
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abstract = "Objective: Extraperitoneal 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 Methods: Between 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. Results: The 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. Conclusion: A 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.",
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AB - Objective: Extraperitoneal 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 Methods: Between 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. Results: The 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. Conclusion: A 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.

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