Laparoscopic radical prostatectomy--the experience of the German Laparoscopic Working Group.
OBJECTIVE
To present the current status of laparoscopic radical prostatectomy (LRP) in Germany, Austria and Switzerland with respect to transferability, learning curve, and outcome.


METHODS
The data of 5824 patients who underwent LRP in 18 centers by 50 urologists from March 1999 to August 2004 were analyzed retrospectively. Three centers performed more than 500, and six more than 250 cases. A transperitoneal descending technique with was used in 2701, a transperitoneal ascending in 1234, an extraperitoneal descending in 1814, and an extraperitoneal ascending modification in 75 cases. Specimen showed pT2 in 3535, pT3a in 1555, pT3b in 623, and pT4 in 111 cases.


RESULTS
Mean operating time averaged 211 (131-292) minutes, with shorter duration of the extraperitoneal descending technique. Conversion to open surgery averaged 2.4 (0-14.1) %. Re-intervention rate amounted to 2.7 (0.3-7.7) %. Complication rate averaged 8.9 (1.8-10.8) % including bleeding (0.3-2.5%) and rectal lesion (1.5-2.5%). The rate of positive margins was 10.6 (3.2-18) % for pT2- and 32.7 (20-38.5) % for pT3a-tumors Continence after 12 months was 84.9 (72-94) %. Data about potency (7 centers) revealed 52.5 (35-67) % full erections following bilateral nerve preservation. 5 year-PSA recurrence rate (3 centers) was 8.6 (4-15.3) % for pT2-tumors and 17.5 (15-20.6) % for pT3a-stages.


CONCLUSIONS
The results confirm the efficacy of the training program with safe transfer of LRP (i.e. low complication rate), however including all known problems of a retrospective study.
Rassweiler
Jens
J
Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Am Gesundbrunnen 20, D-77074 Heilbronn, Germany. jens.rassweiler@slk-kliniken.de
Stolzenburg
Jens
J
Sulser
Tullio
T
Deger
Serdar
S
Zumbé
Jürgen
J
Hofmockel
Georg
G
John
Hubert
H
Janetschek
Günther
G
Fehr
Jean-Luc
JL
Hatzinger
Martin
M
Probst
Michael
M
Rothenberger
Karl-Heinz
KH
Poulakis
Vassilis
V
Truss
Michael
M
Popken
Gralf
G
Westphal
Jens
J
Alles
Uwe
U
Fornara
Paolo
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D005858:Germany; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013557:Switzerland