Laparoscopic radical prostatectomy: a multi-institutional study of conversion to open surgery

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Laparoscopic radical prostatectomy (LRP) is a common procedure for prostate cancer.
• Conversion to open radical retropubic prostatectomy (RRP) can occur during LRP.
• Understanding conversion rates and contributing factors is crucial for surgical training and patient selection.

Purpose of the Study:

• To determine the incidence of conversion from LRP to RRP.
• To identify factors associated with conversion during LRP.
• To analyze outcomes of patients requiring conversion to open surgery.

Main Methods:

• Multi-institutional review of 670 LRP cases across seven institutions.
• Analysis of clinical, operative, and pathologic data for patients converted to RRP.
• Assessment of functional outcomes (continence, potency) at 6 months post-conversion.

Main Results:

• Conversion rate from LRP to RRP was 1.9% (13 of 670 cases).
• Common conversion points included apical and posterior seminal vesicle dissection.
• Failure to progress, adjacent structure injury, and hypercarbia were primary causes.
• Obesity and prior pelvic surgery were associated comorbidities.
• Conversions were more frequent during surgeons' initial LRP cases (6 of 13 in first 5 cases).

Conclusions:

• Open conversion during LRP is infrequent but linked to surgeon experience and patient factors.
• Careful patient selection is recommended for surgeons new to LRP, avoiding obese or previously operated patients.
• Functional outcomes, including continence and potency, are not significantly impacted by open conversion.