Extraperitoneal laparoscopic radical prostatectomy: a prospective evaluation of 600 cases

We report our experience with the extraperitoneal approach to laparoscopic radical prostatectomy. We describe the technique, clinical and oncological results, and functional outcome.

From February 2002, to March 2004, 600 laparoscopic radical prostatectomies were performed by an extraperitoneal approach and evaluated prospectively.

A total of 599 extraperitoneal procedures were performed successfully. Mean operative time was 173 minutes. Mean operative blood loss was 380 cc. The transfusion rate was 1.2%. The major and minor complications rate was 2.3% and 9.2%, respectively. The reoperation rate was 1.7%. Mean hospital stay was 6.3 days. Pathological stage was pT2 and pT3 in 72% and 28% of cases, respectively. Mean Gleason score was 7. The overall positive margin rate was 17.7% (14.6% and 25.6% of pT2 and pT3 tumors, respectively). Median followup was 12 months. Of the patients 95% had prostate specific antigen less than 0.2 ng/ml. Patients were evaluated by a self-questionnaire sent by mail before and after surgery (International Continence Society and International Index of Erectile Function-5). At a median followup of 12 months 84% of the patients were continent (no pad), 7% used 1 precautionary pad and 7% needed 1 pad routinely. At a median followup of 6 months in preoperatively potent patients (International Index of Erectile Function-5 greater than 20) the postoperative erection and intercourse rate was 64% and 43%, respectively, in those with bilateral nerve bundle preservation.

The extraperitoneal technique is a reliable approach to laparoscopic radical prostatectomy.