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Laparoscopic radical prostatectomy: assessment after 550 procedures
Bertrand Guillonneau1, Xavier Cathelineau, Jean-Dominique Doublet
1Department of Urology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, Paris, France. bertrand.guillonneau@imm.fr
Purpose:
To evaluate our experience in laparoscopic radical prostatectomy.
Materials And Methods:
Between January 1998 and December 2000, 550 consecutive patients eligible for radical prostatectomy, were operated laparoscopically. Data concerning surgery and post-operative course were assessed and recorded. Oncological data were assessed by pathological examination and post-operative PSA level. Functional results were assessed with a self-questionnaire.
Results:
The mean operating time was 170 min for the last 350 patients. Surgical conversion was necessary in seven patients (1.3%). Mean intra-operative bleeding was 290 ml (range: 50-1500 ml) for the last 350 patients. The overall transfusion rate was 5.27%. Mean bladder catheterization time was 4.2 days and median postoperative stay was 5 days in the last 350 patients. By pathological stage, 4 pT2a specimens (3.3%), 48 pT2b specimens (15%), 21 pT3a specimens (33%), 19 pT3b specimens (47%) were found to have positive surgical margins. For pT2a and pT2b stages, non-biological recurrence probability (PSA<0.1 ng/ml) is, respectively, 92.3% at 36 months, and 86.3% at 31 months. The continence rate (no pad) was 82.3% at 12 months among the 255 first patients. For 47 consecutive selected patients, spontaneous erection rate was 85 and 66% experienced spontaneous intercourse.
Conclusions:
Laparoscopic radical prostatectomy is currently feasible, with low perioperative morbidity. Taking into account the postoperative follow-up, oncological results are identical to those obtained with conventional surgery. The functional results are encouraging.