Laparoscopic prostatectomy: here to stay

In 2002, open retropubic radical prostatectomy remains the standard of care for localized carcinoma of the prostate. However, the laparoscopic approach offers several appealing advantages and is being practiced more widely. The more commonly performed technique is the transperitoneal "Montsouris" technique with defined steps which are described. There are a number of pointers that are learned with experience. The most remarkable aspect of laparoscopic prostatectomy is the relatively pain-free and trouble-free postoperative course. Patients can be discharged within 2 days, have very little analgesic requirement, and feel well faster. The catheter can be removed in 4 to 7 days. Cancer control appears comparable to that of open surgery, although results are relatively preliminary and are stated in terms of biochemical freedom from disease. The functional results continue to be reported, but in an experienced surgeon's hands, continence appears to recover more quickly and appears to be similar to that achieved after open surgery. Potency can be preserved with nerve sparing. Laparoscopic radical prostatectomy is a procedure that will be more widely practiced in North America as several of the technological limitations are overcome and as surgeons become more experienced with laparoscopic surgery.