Laparoscopic radical prostatectomy: technique

Ongoing progress in laparoscopy has permitted extension of its indications for performance of complex oncologic and reconstructive surgeries such as radical prostatectomy. Laparoscopic radical prostatectomy is now feasible when performed by urologists trained in laparoscopy. Although the procedure is technically rewarding, it is more important to evaluate it in regards to efficacy. The short-term oncologic and functional efficacy rates (regarding urinary continence) seem equivalent to the rates for open surgery. Longer follow-up is needed to assess the preservation of potency with the laparoscopic technique. The integration and application of open nerve-sparing techniques to the laparoscopic approach should be feasible owing to the excellent visual accuracy at the prostatic apex. Initially, the operating time is lengthy (> 7 hours), but the length improves considerably with each series of 20 or more cases. Overall, the learning curve for laparoscopic radical prostatectomy is approximately 50 cases. Whether the laparoscopic approach will ever be as time efficient for the urologist as open radical prostatectomy remains to be seen. The authors' preliminary impression from the patient's perspective is that laparoscopic prostatectomy may offer significant advantages over open surgery in terms of the immediate postoperative quality-of-life concerns.