Laparoscopic radical prostatectomy a review of the literature and comparison with open techniques

Laparoscopic Radicai Prostatectomy without Ligation of the Santorini's VenousPlexus

Background

The goal of our work is to demonstrate how, in the approach to laparoscopic radical prostatectomy, the ligation of Santorini's dorsal venous complex is not necessary. The retrospective evaluation of video-laparoscopich radical prostatectomy performed at UOC of Jesi with this technical device, showed an increased blood loss compared to a technique that provides for the ligation of Santorini's plexus and, overall, reduced blood loss compared with the average radical open prostatectomy.

Material and Methods

50 video-laparoscopic extraperitoneal radical prostatectomies were evaluated, which were performed with the same technique and by the same operator. The technique involves the non-ligation of Santorini's venous plexus. Surgical, oncological, functional outcomes were considered and in particular blood loss.

Results

The results are consistent with those reported in literature, and without ligation of the Santorini's venous plexus, there has been no increase in blood loss intra-and / or post-operatively or in the percentage of patients with hemotransfusion.

Conclusion

The video-laparoscopic radical prostatectomy, although a not yet codified and standardized technique for the treatment of organ-confined prostate cancer, did show oncological and functional results basically I similar to open-sky technique. But compared to this, it has certainly demonstrated a lower blood loss and a reduction of morbidity. The non ligation of Santorini's venous plexus, always necessary during open prostatectomy, in our experience is not necessary in video-laparoscopy

Safe removal of the urethral catheter 2 days following laparoscopic radical prostatectomy

Purpose. To assess the risks and benefits of early urethral catheter removal following laparoscopic radical prostatectomy. Materials and Methods. Between June 2009 and April 2011, 114 patients underwent laparoscopic radical prostatectomy for clinically organ-confined prostate cancer. Candidates for early removal of the urethral catheter were selected intraoperatively on the basis of the integrity of the vesicourethral anastamosis and the ease of recatheterisation. In the selected cohort of patients, the urethral catheter was removed at day 2. Recatheterisation rates within this group were recorded and analysed. Results. Of the 114 patients who underwent laparoscopic prostatectomy, 64 (56%) were deemed suitable for removal of catheter on second postoperative day prior to discharge. The first 20 patients selected for early removal of urethral catheter were covered with a suprapubic catheter inserted at the time of surgery. Out of 64 patients deemed suitable for early removal of urethral catheter, 53 (83%) were able to pass urine without complication. 11 patients (17%) developed urinary retention that necessitated recatheterisation. In all cases, reinsertion of catheter was performed easily and successfully without the need for cystoscopic guidance or adjuncts. Conclusions. Removal of the urethral catheter at day 2 following laparoscopic prostatectomy is a safe procedure in carefully selected patients.

A cost-analysis comparison of laparoscopic radical prostatectomy versus open radical prostatectomy: the McMaster Institute of Urology experience

INTRODUCTION

The objective of this study was to identify and compare the costs of laparoscopic radical prostatectomy (LRP) and radical retropubic prostatectomy (RRP) at our centre.

METHODS

We conducted a retrospective chart review of our first 70 consecutive LRP cases and 70 consecutive RRP cases at St. Joseph's Healthcare in Hamilton, Ontario, Canada. We performed cost analysis, including operating room costs, disposable instruments, blood transfusions, analgesic requirements and length of hospital stay. Overall expenses were then analyzed and compared.

RESULTS

Preoperative patient demographics and disease stages were comparable between the LRP and RRP groups. On a per procedure basis, large discrepancies were found in mean disposable instrument costs (LRP = $659.18 vs. RRP = $236.59), operating room costs (LRP = $4278.00 vs. RRP = $3139.00), mean cost of blood transfusions (LRP = $21.00 vs. RRP = $394.34), mean analgesia requirements (LRP = $12.94 vs. RRP = $41.06) and mean hospital stay bed costs (LRP = $3690.00 vs. RRP = $5027.14). Overall, costs for all patients in the LRP and RRP groups, respectively, were $606 307.29 and $618 721.57 with a cost saving of $12 414.28 in favour of the LRP arm.

CONCLUSION

At our institution, we found that LRP costs are slightly less than those for RRP. Higher operative time and disposable instrument expenses are offset by the shorter hospital stays, fewer blood transfusions and less analgesic requirements for the LRP group. Further financial advantages for LRP will likely be achieved with additional reduction of operating room time and by minimizing disposables.

Laparoscopic radical prostatectomy: a review

INTRODUCTION

We offer an overview of the intra-, peri- and postoperative outcomes of laparoscopic radical prostatectomy (LRP) with the endpoint to evaluate potential advantages of this approach.

MATERIALS AND METHODS

We conducted an extensive Medline literature search (search terms "laparoscopic radical prostatectomy" and "radical prostatectomy") from 1990 until 2007. Only full-length English language articles identified during this search were considered for this analysis. A preference was given to the articles with large series with more than 100 patients. All pertinent articles concerning localized prostate cancer were reviewed.

CONCLUSION

Pure LRP has shown to be feasible and reproducible but it is difficult to learn. Potential advantages over open surgery have to be confirmed by longer-term follow-up and adequately designed clinical studies.

Oncological outcome of laparoscopic prostatectomy

AIM

Oncological outcomes including surgical margin status and biological progression-free survival (bPFS) were analyzed in patients who underwent laparoscopic prostatectomy (LRP) only.

METHODS

A total of 136 patients who underwent LRP only without lymph node metastasis or perioperative supportive therapy between April 2000 and October 2005 were analyzed. All patients received > or =6 months postoperative follow-up. Biological progression was defined as elevation of prostate-specific antigen by >0.2 ng/mL.

RESULTS

The positive margin (ew+) rate was 36.8% and the 3-year bPFS was 72.6% for all patients. Positive margin rates in pT2a-b, pT2c, pT3a and pT3b were 10.0%, 27.5%, 77.3% and 53.8%, respectively. Three-year bPFS rates in pT2, pT3a and pT3b were 91.8%, 66.8% and 44.9%, respectively. Although the positive margin rate at posterior and anterior sites decreased as more patients were recruited, no significant improvements were observed at apex and base sites. Three-year bPFS rates in pT2 ew-, pT2 ew+, pT3 ew- and pT3 ew+ were 95.8%, 85.7%, 81% and 48.5%, respectively, indicating that positive margins exert a greater impact in pT3 disease than in pT2 disease.

CONCLUSIONS

Although 3-year bPFS results were almost identical to previous reports of LRP and retropubic radical prostatectomy, the positive margin rate in pT3a disease was particularly high, probably due to immature surgical skill. Although positive margins at posterior and anterior sites decreased with the leaning curve, improvements are needed to reduce positive margin rates at the apex. Positive margins exert greater impact in pT3 disease than in pT2 disease.

Fast-track surgery in laparoscopic radical prostatectomy: basic principles

Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase. The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer. Twenty-five patients each were randomized in the study groups to verify if a fast-track regimen could be transferred into clinical routine. The perioperative data, early complications, hospital stay as well as readmission rate were analyzed. The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group. The overall complications were significantly less in the fast-track procedure. The readmission rate was low and not significant. Patients receiving an LRPE benefit from a suitable fast-track concept. The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate. Thus, fast-track concepts might contribute to saving resources in the long term. However, more evidence based on larger prospective trials is needed to achieve optimal quality of life for patients perioperatively.

Laparoscopic and Robotic Assisted Radical Prostatectomy – Critical Analysis of the Results

OBJECTIVE

To evaluate the role of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RLRP) based on personal experience and a review of the literature.

MATERIAL AND METHODS

Own experience at one European and one American LRP-center includes more than 2000 cases. We performed a MEDLINE search reviewing the literature on LRP and RLRP between 1992 and 2005 with special emphasis on historical aspects, technical considerations, comparison to open retropubic (RRP) and perineal radical prostatectomy (PRP), laparoscopic training, and the cost-efficiency of the techniques.

RESULTS

Based on sophisticated training programs a continuous dissemination of the technique took place. In the United States, this process was accelerated by the use of the daVinci-robot. There is a trend towards the extraperitoneal access. Mid-term outcomes of LRP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower rate of complications, shorter convalescence, and better cosmesis. In contrast to RLRP, LRP may reach cost-equivalence with open surgery (i.e. by reduction of OR-time, use of multi-usable instruments).

CONCLUSIONS

LRP reproduces the excellent results of open surgery providing the advantages of minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow. In contrast the United States, the use of robots is likely to remain limited in Europe.

Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomised, single-surgeon study

OBJECTIVES

To prospectively compare intra- and peri-operative outcomes of open radical retropubic prostatectomy (RRP) and laparoscopic prostatectomy (LRP) by a single surgeon.

PATIENTS AND METHODS

One-hundred-twenty, consecutive, age-matched patients diagnosed with clinically localized prostate cancer were eligible for surgery. Sixty patients underwent RRP and 60, LRP. Intra- and peri-operative parameters, pathologic findings and early complications were recorded. A validated visual analogue scale was used to assess pain in the recovery room, 3 h after the operation and on post-operative days 1, 2 and 3. A cystogram was performed on post-operative day 5.

RESULTS

Operating time was significantly shorter in the RRP group versus the LRP group (mean+/-SD, 170+/-34. 2 vs 235+/-49.9 min, p<0.001). Blood loss was significantly less in the LRP group versus the RRP group (mean+/-SD, 853.3+/-485 vs 257.3+/-177 ml, p<0.001), but no patient in either group underwent early re-intervention for bleeding. The RRP group showed a trend for higher use of analgesia. A watertight anastomosis was shown at cystourethrography and the catheter removed in 86% and 66% of LRP and RRP patients, respectively. The overall percentage of post-operative complications and positive margins were comparable.

CONCLUSION

Laparoscopic prostatectomy is an attractive alternative to open prostatectomy, offering the advantages of reduced blood loss and safe early catheter removal. Furthermore, the laparoscopic procedure proved to be safe oncologically. Long-term follow-up is required to compare functional results in terms of continence and potency.

An evaluation of information available on the internet regarding minimally invasive hip arthroplasty

The Internet is a popular source of information regarding health care especially when seeking advice on new and less invasive surgical techniques. We evaluated 150 Web sites (3 search engines) for authorship and quality of information regarding minimally invasive hip arthroplasty. The results revealed that 45% were authored by a hospital/university, 26% were news stories, 25% were private medical groups, and 6% were orthopedic industry Web sites. Forty-five percent offered the opportunity to make an appointment, 41% described the surgical technique, and only 15% explained eligibility. Thirteen percent described the risks, whereas 9% made reference to peer-reviewed publications. More than 91% made specific claims regarding the advantages of minimally invasive surgery. Our study suggests the information on the Internet regarding minimally invasive total hip arthroplasty is misleading and of poor quality.