Endoscopic extraperitoneal radical prostatectomy: An initial report following the first 30 cases

To present initial observations after the first 30 cases of endoscopic extraperitoneal radical prostatectomy carried out at our department, which so far has had no experience with this surgical procedure.

In the period of 15 months a group of 30 patients with organ confined prostate cancer, underwent endoscopic extraperitoneal radical prostatectomy using Montsouris technique. All procedures were performed by the same team of two urologists and one resident.

The mean age of the patients was 65.3 years (43-73 years), the mean preoperative prostate specific antigen (PSA) was 7.2 ng/ml (4-9.8 ng/ml), the mean prostate volume measured in TRUS was 41 cm³ (25-80 cm³). The mean operative time was 3 h 55 min (3 h 15 min - 5 h 30 min). The negative margin was achieved in 26 patients (86%). In seven patients (23%) blood transfusion was required. Three patients had intraoperative rectal injury. In two cases trauma was supplied laparoscopically, and in one case it was decided to perform diverting colostomy. The majority of patients (65%) were discharged home on the fifth day after surgery. Two months postoperatively 13 patients (43%) were continent, 16 (35%) presented moderate stress incontinence with occasional urine leakage during normal activity and 1 patient (3%) presented severe stress incontinence.

Endoscopic extraperitoneal radical prostatectomy during the early phase of learning is technically difficult, requiring from the operator the laparoscopic skills, determination and a thorough knowledge of the theoretical basis of the subsequent stages of the procedure. Urologists who start performing this procedures must be aware of possible intra as well as postoperative complications.