[Laparoscopic vs. open surgical lymphadenectomy in prostate cancer. Methodological comparison]

Bilateral laparoscopic pelvic lymph node dissection was performed in 27 consecutive patients with stage B prostatic carcinoma. The first 5 operations (learning phase) were compared with the next 22 procedures and with a group of 20 patients who had undergone conventional open lymphadenectomy previously. Retropubic radical prostatectomy was done in 22 patients with negative nodes. All residual lymphatic tissue was removed. During the learning phase the average operating time was 3 h 40 min. The mean number of laparoscopically removed nodes was 5.8 on both sides. At open operation we found 1.5 residual nodes on the right side and 5.3 residual nodes on the left. In one case one of the residual nodes was positive for tumor. Operating time in the next 22 patients was 2 h 20 min. The number of nodes removed laparoscopically was 8.3 on the right and 7.0 on the left. Residual nodes were found in only 3 patients. None of these nodes was positive for tumor. In both groups the number of nodes removed was greater than in the group of patients who underwent open lymphadenectomy. In one of the first 5 patients immediate open surgery was required because of bleeding. In 1 patient's nodes evidence of Hodgkin disease was found. This was the only patient to develop a lymphatic fistula. There were no lymphoceles. We feel that laparoscopic pelvic lymphadenectomy has a definite learning curve but is a safe staging procedure for prostatic cancer with results equivalent to those of the open operation.