title: Laparoscopic radical prostatectomy: preliminary results.
abstract: OBJECTIVE
  To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures.
  
  
  METHODS
  Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first 10 patients, we performed the vesicourethral reconstruction with interrupted sutures; in the remaining 33 patients, we performed it with two hemicircumferential running sutures. The specimen was removed through the umbilical port site.
  
  
  RESULTS
  Once the developmental phase with the first 10 patients was concluded, the median operating time was 4.3 hours without pelvic lymphadenectomy, and the median postoperative bladder catheterization was 4 days. Two (4.7%) of 43 patients underwent transfusion. Twelve patients (27.9%) had positive surgical margins; all patients had a postoperative prostate-specific antigen level of less than 0.1 ng/mL at 1 month. Rectal injury occurred in 1 patient, requiring colostomy, and 4 patients had urethrovesical anastomotic leakages requiring surgical repair. One month postoperatively, 36 patients (84%) were fully continent (no leakage). Six patients had had erections, and four stated they had had sexual intercourse.
  
  
  CONCLUSIONS
  Laparoscopic radical prostatectomy has evolved to a fully standardized and reproducible procedure. The short-term oncologic and functional efficacy rates are equivalent to those for open surgery. The operating time is reasonable once the learning curve is over, and postoperative morbidity is diminished. Because of the improved visual accuracy, permitting more precise dissection, this technique has the potential to become an important advancement in urologic surgery.
authors.affiliation: Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: C C
authors.initials: CC
authors.lastname: Abbou
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.forename: A
authors.initials: A
authors.lastname: Hoznek
authors.forename: P
authors.initials: P
authors.lastname: Antiphon
authors.forename: A
authors.initials: A
authors.lastname: Cicco
authors.forename: F
authors.initials: F
authors.lastname: Saint
authors.forename: W
authors.initials: W
authors.lastname: Alame
authors.forename: J
authors.initials: J
authors.lastname: Bellot
authors.forename: D K
authors.initials: DK
authors.lastname: Chopin
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D015203:Reproducibility of Results