Piotr Chłosta 1, Jarosław Jaskulski 1, Paweł Orłowski 1, Ireneusz Szymański 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 laparoscopy allows to perform radical prostatectomy from transperitoneal and retroperitoneal approach.
- Objectives. Aim of the study is to present the operative parameters based on first 29 endoscopic radical prostatectomies (LPR) with utilization of retroperitoneal approach.
- Materials and methods. From January 2004 to January 2006, 49 endoscopic laparoscopic radical prostatectomies due to organ confined prostate cancer (cT2ŁN0M0) were performed. The rate of endoscopic procedures among all radical prostatectomies was 89%. Retroperitoneal endoscopic technique (EPR) was performed in 29 cases. The working space was 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 were inserted. The patient was placed in a deflected supine position with 30 Trendelenburg decline. The procedure was started from dissection the Retzius space, incision the pelvic fascia and dissection the apex and cutting the urethra. Than the procedure was continued from incision the bladder neck and division of seminal vesicles and posterior surface of the prostate. During the procedure the Ligasure system, bipolar scisors and forceps were used.
- Results. In 29 cases radical prostatectomy was preformed endoscopically in retroperitoneal space. In two cases (7%) EPR was converted to laparoscopic transperitoneal technique, because unintentional opening the peritoneal cavity. In one case rectal injury was found intraoperatively, successfully treated by laparoscopic suturing. There was no other complication during EPR. The vesicourethral anastomosis was performed with absorbable sutures 3/0. The mean number of the single, knot sutures was 5 (4-6), with knots tied outside the anastomosis. A 14 F suction drain was introduced via right iliac trocar, and placed in the Retzius space. The mean time of operation was 150 min (110-210 min). The mean blood loss during EPR was 150 mL (from 110 to 350 mL). Blood transfusion was not necessary in any case of LPR. There was no postoperative complications. Surgical outcome based on back to vital activity / back to normal diet and hospitalization time was 2 and 5 (4-7) days respectively, and was significantly shorter than after standard, open procedure (p<0.005). The median catheterization time was 18 (5-21) days. Pathological results of the postoperative specimens were pT2a in 9 patients (31%), pT2b in 18 (62%), pT3a in 1 (3.5%), and pT3b in 1 (3,5%) patient. In two patients (7%) positive surgical margin were found.
- Conclusions. EPR is an effective, safe and considerably less invasive procedure than open radical prostatectomy. To make the effective working space during retroperitoneal procedure usage of balloons devices is not necessary. Bipolar instruments and Ligasure system facilitate the operation. 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.