1635 IMPLICATIONS OF LAPAROSCOPIC INGUINAL HERNIA REPAIR ON OPEN, LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111635 IMPLICATIONS OF LAPAROSCOPIC INGUINAL HERNIA REPAIR ON OPEN, LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY Daniel Spernat, Henry Woo, David Sofield, Daniel Moon, and Mark Louie-Johnsun Daniel SpernatDaniel Spernat Sydney, Australia More articles by this author , Henry WooHenry Woo Sydney, Australia More articles by this author , David SofieldDavid Sofield Perth, Australia More articles by this author , Daniel MoonDaniel Moon Melbourne, Australia More articles by this author , and Mark Louie-JohnsunMark Louie-Johnsun Gosford, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical Prostatectomy (RP) can be a challenging operation. Further, tissue planes may be compromised by previous Laparoscopic Inguinal Hernia Repair (LIHR). Surgeons have anecdotally reported that RP has had to be abandoned after LIHR. We prospectively collected data from four experienced prostate surgeons from separate institutions. We report on our experience with open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RARP). Our objective was to evaluate the success rate of performing RP with the three most common operative techniques, Lymph Node Dissection (LND), and the frequency of complications after LIHR. METHODS A prospective database recorded clinical and pathological T stage, PSA, Gleason grade, success or failure to perform RP, success or failure to perform LND, unilateral or bilateral mesh, type of RP and complications. RESULTS A total of 57 men underwent RP after LIHR. 28 had a previous bilateral LIHR, and 29 unilateral. An ORP was attempted in 19 patients, LRP in 33, and RARP in 5. All 57 cases were able to be successfully completed. LND was based on individual surgeon preference. Of the 19 ORP a LND was attempted in 18 cases. Only 10 of the 18 open LND were able to be completed (55.6%). Of the 33 laparoscopic cases, LND was attempted in 22. Only 4 (18.2%) of these cases were able to have a bilateral LND and a further 9 (40.9%) had a unilateral dissection. Robotic LND was possible in 5 of 5 cases (100%). Combining data from all methods of RP, a LND was attempted in 44 of the 57 patients (77.2%). The LND had to be abandoned in 16 (36.4%) of the patients. Additionally in 9 (20.5%) patients only a unilateral LND was possible due to mesh covering the nodes and external iliac vessels. Thus it was not possible to complete a LND in 25 of the 44 patients (56.8%). Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, one rectourethral fistula in a salvage procedure post failed HIFU, one bladder tear, two blood transfusions, one prolonged lymph leak (5 days), one urinoma, one episode of acute urinary retention, one wound infection, and one bladder neck contracture. CONCLUSIONS LIHR is not a contra-indication to RP. ORP, LRP, and RARP after LIHR is a safe and reasonable treatment option for patients with prostate cancer. However, it may not be possible to perform a LND in up to 56.8% of patients. Thus prior to undertaking LIHR, a PSA and DRE should be performed in age appropriate men. Further, minimally invasive approaches may offer higher success rates with LND compared to open surgery following LIHR. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e656 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Spernat Sydney, Australia More articles by this author Henry Woo Sydney, Australia More articles by this author David Sofield Perth, Australia More articles by this author Daniel Moon Melbourne, Australia More articles by this author Mark Louie-Johnsun Gosford, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...