Laparoscopic radical prostatectomy: the Montsouris experience

We evaluate our experience with laparoscopic radical prostatectomy.

Between February 1, 1998 and May 1, 1999, 120 consecutive patients underwent laparoscopic radical prostatectomy. Morbidity of the first 40 (group 1), next 40 (group 2) and last 40 (group 3) procedures was compared. Oncological data were assessed by pathological examination and postoperative prostate specific antigen (PSA). Functional results were assessed by a self-administered questionnaire for the first 60 patients and potency was assessed in the last 40.

Mean operating time plus or minus standard deviation was 239+/-59 minutes (range 150 to 450) for the series, and 282, 247 and 231, respectively, for groups 1, 2 and 3. Surgical conversion was necessary in 7 cases (5.8%) overall, including 10% (4) in group 1, 7.5% (3) in group 2 and 0% in group 3. Mean intraoperative bleeding was 402+/-293 ml. (range 50 to 1,500) in the series, and 534, 517 and 277, respectively, for groups 1, 2 and 3. The transfusion rate was 10% overall, and 15%, 12.5% and 2.5%, respectively, in groups 1, 2 and 3. The reoperation rate was 1.7%. Mean postoperative bladder catheterization time was 6.6+/-2.4 days. The positive and questionable surgical margin rate was 15%. Pathological tumor stage was pT2a in 4 specimens (11%), pT2b in 11 (16%), pT3a in 0 and pT3b in 3 (50%) with positive surgical margins. PSA assays were available in 94 patients with a mean postoperative followup of 2.2 months (range 1 to 12). Serum PSA was 0.1 ng./ml. or less in 89 men (94.7%). The continence rate at 6 months postoperatively was 72% among the first 60 patients. Of 20 group 3 patients who were sexually active preoperatively 9 (45%) reported postoperative spontaneous erections. The overall cost of retropubic radical prostatectomy was about $1,237 more than that for laparoscopy.

Laparoscopic radical prostatectomy is feasible and perioperative morbidity is low. Based on our postoperative followup, oncological results are identical to those of conventional surgery and functional results are encouraging.