title: Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases.
abstract: OBJECTIVE
  We report the outcome of 2400 endoscopic extraperitoneal radical prostatectomy (EERPE) cases performed in three institutions, with emphasis on the evolution of the EERPE technique.
  
  
  METHODS
  In total, 2400 EERPE procedures were performed in three institutions. Several surgeons performed the operations. The presented cases also include the learning curve of the surgeons. EERPE was performed in all cases of localized prostate cancer with the same indications to open and transperitoneal laparoscopic radical prostatectomy.
  
  
  RESULTS
  Average patient age was 63.3 years (range 41-81 years), and mean preoperative prostate specific antigen (PSA) level was 9.8 ng/mL (range 0.08-93 ng/mL); 857 (38%) patients had previously undergone abdominal or pelvic surgery, while 143 (5.8%) patients had prior prostatic treatment. Pelvic lymph node dissection took place in 1219 (50.8%) patients. Bilateral nerve sparing was performed in 672 patients and unilateral in 284 patients; 100 patients underwent intraoperative hernia repair with mesh placement (82 unilateral and 18 bilateral). Mean operative time was 150.7 minutes (range 50-340 minutes). Conversion to open surgery was never deemed necessary. Fifteen patients received transfusion (0.7%). The mean catheterization time was 6.19 days (range 3-40 days). Overall, 71.7% and 94.7% of the patients were continent at 3 and 12 months, respectively. Totally, 956 patients were treated with nerve-sparing procedure either interfascial or intrafascial; 672 patients underwent bilateral neurovascular bundle preservation, and 284, unilateral. Younger patients tend to have better postoperative potency. Bilateral nerve-sparing EERPE in patients younger than 55 years results in potency rate of 32.4%, 75.3%, and 84.9% at 3, 6, and 12 months postoperatively.
  
  
  CONCLUSIONS
  The functional and oncological outcome of EERPE is comparable to other approaches for radical prostatectomy. Continuous refinements contribute to the improving outcome of the procedure. Long-term results especially in terms of oncological efficacy are expected.
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.forename: Do
authors.initials: D
authors.lastname: Minh
authors.forename: Anja
authors.initials: A
authors.lastname: Dietel
authors.forename: Tim
authors.initials: T
authors.lastname: Häfner
authors.forename: Dimitris
authors.initials: D
authors.lastname: Dimitriou
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Al-Aown
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.forename: Evangelos N
authors.initials: EN
authors.lastname: Liatsikos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010537:Peritoneum / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011467:Prostate / Q000294:innervation / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D014549:Urinary Incontinence / Q000150:complications