Piotr Chłosta 1, Paweł Orłowski 1, Jarosław Jaskulski 1, Mateusz Obarzanowski 1, Jakub Dobruch 2, Andrzej Borówka 2
- 1 Dział Urologii, Świętokrzyskie Centrum Onkologii w Kielcach
2 Klinika Urologii, I Zespół Dydaktyki Urologicznej CMKP, Międzyleski Szpital Specjalistyczny w Warszawie
- Introduction. The development of endovision techniques in urology makes possible to perform radical prostatectomy from retroperitoneal approach.
- Objectives. Aim of the video is to present the operative technique of retroperitoneal endoscopic radical prostatectomy (EPR).
- Materials and methods. The video was realized after gaining experience on EPR performed from January 2004 to January 2006 in 29 cases of organ confined prostate cancer (cT2 łN0M0). The working space is done by tissues-fingers dissections and insufflations the cavity under full visual control, without the Gaur-baloon - device. Then both 5 mm trocars and 3 trocars of 10 mm are inserted. The procedure is started from dissection the Retzius space, incision the pelvic fascia and dissection the apex and cutting the urethra. Than the bladder neck is incised and seminal vesicles and posterior surface of the prostate are devided. During the procedure the Ligasure system, bipolar scissors and forceps are used. The vesicourethral anastomosis is performed with absorbable sutures 3/0. The mean number of single knot sutures is 5 (4-6), with knots tied outside the anastomosis. A 14 F suction drain is introduced via right iliac trocar, and placed in the Retzius space.
- Results. In all 29 patients radical prostatectomy was preformed laparoscopically in retroperitoneal space. In one case rectal injury was found intraoperatively, successfully treated by laparoscopic suturing. There was no any other complication during EPR.
- Conclusions. LPR is an effective, safe and considerably less invasive procedure than open radical prostatectomy. To make the effective working space during retroperitoneal procedure usage balloon devices is not necessary. Low capacity of working space makes the procedure more difficult than transperitoneal laparoscopic radical prostatectomy, but the 'learning curve' of the EPR in the team with experience of laparoscopic surgery is significantly shorter, than we judged before the introduction of this technique as a routine. EPR allows to perform efficient excision of the prostate, especially in cases of low volume glands. Bipolar instruments and Ligasure system facilitate to conduct the operation.