Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations.
BACKGROUND
Our purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy.


METHODS
We describe an original technique of laparoscopic radical prostatectomy performed in 65 successive patients during 11 months.


RESULTS
Radical prostatectomy was performed entirely by laparoscopy in 59 patients (91%). The median operating time was 265 min, including times for lymphadenectomy performed in 33% of patients. Preoperative complications included one rectal injury, sutured laparoscopically with an uneventful postoperative course, and one epigastric artery injury which needed secondary open procedure. The transfusion rate was 15.4% (10 patients). Median postoperative vesical catheterization lasted 7 days. The reduction of postoperative pain allowed rapid discharge of patients, by the fourth postoperative day in 60% of consenting patients. As regards oncological results, resection margins were negative in 57 patients (87.7%). The last prostate-specific antigen (PSA) assay was undetectable (<0.1 ng/ml) in 85.7% of the 42 patients in whom PSA was available more than 1 month after the operation.


CONCLUSIONS
Radical prostatectomy can be routinely performed by laparoscopy by an experienced team. Short-term oncological data were identical to the results of conventional retropubic surgery, and morbidity was low. The laparoscopic approach could constitute in the future a technical improvement over radical prostatectomy if long-term oncological results are confirmed and if improvement of intraoperative vision improves the functional results of this operation.
Guillonneau
B
B
Department of Urology, Institut Mutualiste Montsouris, Paris, France. bguillonneau@imm.fr
Vallancien
G
G
D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*