title: Feasibility and usefulness of laparoscopic radical prostatectomy: Kobe University experience.
abstract: OBJECTIVE
  The objective of this study was to present the clinical outcomes of 26 patients who underwent laparoscopic radical prostatectomy at our institution.
  
  
  METHODS
  We performed laparoscopic prostatectomy on patients who were clinical stage T1 or T2. The mean age was 70 years old (range: 52-76). The mean level of pre-treatment prostate-specific antigen (PSA) was 8.7 ng/mL (range: 3.3-45). The Gleason score of the needle biopsy was < 7 in 21 patients and > or = 7 in five patients. Clinical stage was T1c in 17 patients, T2a in 6 patients and T2b in 3 patients. Operative techniques followed those of the French groups. Five trocars were introduced into the peritoneal cavity. The vas deferens and seminal vesicles were dissected to reach the posterior wall of the prostate and the retroperitoneal space was dissected around the urinary bladder. Incision of endopelvic fascia and dorsal vein complex (DVC) ligation were performed. The bladder neck and prostate were divided, then the distal urethra was cut. The lateral pedicles of the prostate were cut and the entire prostate was removed. Vesico-urethral anastomosis was performed at eight points.
  
  
  RESULTS
  Mean operation time was 7 h 30 min. Mean bleeding volume (including urine volume) was 850 mL (range: 32-3135). All patients underwent autologous blood transfusion. Only one patient required further blood transfusion. Gleason scores of resected specimens were < 7 in 10 patients, and > or = 7 in 16 patients. Pathological stage was T0 in 1 patient, T2a in 6 patients, T2b in 13 patients, T3a in 5 patients and T3b in 1 patient. The PSA value was undetectable in all patients one month after surgery. Ten patients who survived for 6 months after surgery had complete urinary continence without a pad. In 7 of the 12 patients who were potent before surgery, neurovascular bundles were preserved, and 5 of them (71%) achieved complete or incomplete erection 3 months after surgery. However, only one patient (14%) could have sexual intercourse.
  
  
  CONCLUSIONS
  Although longer follow-up is necessary to evaluate this surgical technique, laparoscopic prostatectomy seems to be a reasonable option in the treatment of organ-confined prostate cancer.
authors.affiliation: Department of Urology, Kobe University School of Medicine, Kobe, Japan. hara@med.kobe-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Hara
authors.forename: Gaku
authors.initials: G
authors.lastname: Kawabata
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.forename: Shoji
authors.initials: S
authors.lastname: Hara
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okada
authors.forename: Soichi
authors.initials: S
authors.lastname: Arakawa
authors.forename: Sadao
authors.initials: S
authors.lastname: Kamidono
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen