Laparoscopic radical prostatectomy using an extraperitoneal approach: Nordwest hospital technique and initial...

We report on our modifications in technique and initial experience with 255 extraperitoneal laparoscopic radical prostatectomy (eLRP).

Using significant surgical modifications, our laparoscopic method replicates the steps of the retropubic descending RP. We evaluated 255 consecutive patients who underwent an eLRP with pelvic lymph-node dissection.

The mean operative time was 136 minutes (range 84-266 minutes). Because of technical difficulty, the first three patients were converted to open surgery. One major complication, myocardial infarction, and one surgical reintervention in a case of secondary rectourethral fistula after open surgical repair of a laparoscopic rectal injury were observed. The blood transfusion rate was 1.2%. The pathologic stage was pT2a in 56 patients (22%), pT2b in 50 (20%), pT2c in 74 (29%), pT3a in 42 (16%), pT3b in 29 (11%), and pT4 in 3 (2%). Positive margins were found in 7% of patients (13/180) with pT2 tumors and 27% of patients (19/71) with pT3 tumors. The mean catheterization time was 7 days. The continence rates (no pads at all) at 3, 6, and 12 months were 73.7% (146/198), 89.6% (112/125), and 92.7% (38/41), respectively. After a nerve-sparing procedure, the total potency rates at 3 and 6 months were 37.5% (21/56) and 48.8% (21/43), respectively.

The eLRP seems to be safe with short-term oncologic and functional results at least as favorable as those of open radical prostatectomy and classical transperitoneal LRP. The operative times are shorter, and the complication rate appears to be lower.