Radical perineal prostatectomy: development of a new surgical technique that divides the dorsal vein complex.
Standard radical perineal prostatectomy (RPP) was observed by laparoscope through a small suprapubic incision. To increase radicalness, we designed and investigated a new technique of RPP that decreased bleeding and shortened the operation time.


METHODS
Standard RPP was observed by laparoscope through a small suprapubic incision after lymph node dissection in 1 case. In 17 patients with localized prostatic cancer, the dorsal vein complex including the puboprostatic ligament was ligated and divided. The modified RPP was then performed, in which the prostate covered with the prostatic fascia in the anterior region was transected at the bladder neck.


RESULTS
The results of the laparoscopic observation in standard RPP confirmed that the prostatic fascia in the prostatic anterior region had been left and the endopelvic fascia could be broken easily and safely by a clamp or finger from the perineum. With modified RPP the dorsal vein complex was easily ligated and divided without bleeding. The prostate could be transected at the bladder neck with the prostatic fascia attached to the anterior prostate as in RRP. The operation time was 140-190 min (mean 160 +/- 20.1) and the volume of bleeding was 150-512 ml (mean 224 +/- 60.4).


CONCLUSIONS
This modified technique of RPP that transects the dorsal vein complex may replace the current technique of RPP.
Hiraoka
Yasunori
Y
Department of Urology, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan. hiraokay@nms.ac.jp
Shimizu
Yuuji
Y
Abe
Hiroyuki
H
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011467:Prostate / Q000098:blood supply; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D014680:Veins