[Extraperitoneal laparoscopic radical prostatectomy. First 50 cases in a middle sized hospital. Evaluation of the learning curve].
OBJECTIVE
Report our experience in the first 50 cases of laparoscopic radical prostatectomy performed in our Hospital. We describe the surgical technique and the modifications that we have applied. Time consumptions and technical difficulties are reviewed.


METHODS
From January 2005 to September 2006 we indicated 52 extraperitoneal laparoscopic radical prostatectomies. Two of them were done with the advice of a master and won't be included in our series. We followed the Brussels technique with some modifications.


RESULTS
We completed integrally by laparoscopy the 78% of the cases (39/50). The 11 converted cases were done within the 25 first ones. Mean operating time for the pure laparoscopic cases was 280 minutes. We divide surgery in six steps with the following mean times in minutes: Trocars placement (30), seminal vessels dissection (95), Santorini (25), specimen in endobag (55), anasthomosis (55) and final (15). After case 25, the results improve. The most challenging step was seminal vessels dissection. Transfusion rate has been 7%. The mean hospitalization time has been 4 days with a 30% of patients discharged 48 hours after surgery. Positive surgical margins were observed in 12%. Two of our patients presented major complications (4%).


CONCLUSIONS
Extraperitoneal laparoscopic radical prostatectomy is feasible in an institution like ours if it has the aim of invest a big effort, especially regarding operating time. The most demanding steps are the dissection of the vesicoprostatic plane and the anasthomosis. There is a clear progression after case 25.
Peña González
J A
JA
Unidad de Urología, Hospital de Sabadell, Corporació Sanitaria Parc Tauli, Sabadell, Barcelona. miralejos7@yahoo.es
González Sala
J L
JL
Prera Vilaseca
A
A
Abad Gairín
C
C
Graells Batet
A
A
Descalzo Abad
M C
MC
D000368:Aged; D006276:Health Facility Size; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011468:Prostatectomy / Q000193:education* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*