Abstract
BackgroundCurrently, men are younger at the time of diagnosis of prostate cancer and more interested in less invasive surgical approaches (traditional laparoscopy, 3D-laparoscopy, robotics). Outcomes of continence, erectile function, cancer cure, positive surgical margins and complication are well collected in the pentafecta rate. However, no comparative studies between 4th generation 3D-HD vision system laparoscopy and standard bi-dimensional laparoscopy have been reported. This study aimed to compare the operative, perioperative data and pentafecta rates between 2D and 3D laparoscopic radical prostatectomy (LRP) and to identify the actual role of 3D LRP in urology.MethodsFrom October 2012 to July 2013, 86 patients with clinically localized prostate cancer [PCa: age ≤ 70 years, prostate-specific antigen (PSA) ≤ 10 ng/ml, biopsy Gleason score ≤ 7] underwent laparoscopic extraperitoneal radical prostatectomy (LERP) and were followed for approximately 14 months (range 12–25). Patients were selected for inclusion via hospital record data, and divided into two groups. Their patient records were then analyzed. Patients were randomized into two groups: the former 2D-LERP (43 pts) operated with the use of 2D-HD camera; the latter 3D-LERP (43 pts) operated with the use of a 3D-HD 4th generation view system. The operative and perioperative data and the pentafecta rates between 2D-LERP and 3D-LERP were compared.ResultsThe overall pentafecta rates at 3 months were 47.4% and 49.6% in the 2D- and 3D-LERP group respectively. The pentafecta rate at 12 months was 62.7% and 67% for each group respectively. 4th generation 3D-HD vision system provides advantages over standard bi-dimensional view with regard to intraoperative steps. Our data suggest a trend of improvement in intraoperative blood loss and postoperative recovery of continence with the respect of the oncological safety.ConclusionsUse of the 3D technology by a single surgeon significantly enhances the possibility of achieving better intraoperative results and pentafecta in all patients undergoing LERP. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. Nevertheless, further studies are necessary to better comprehend the role of 3D-LERP in modern urology.
Highlights
Men are younger at the time of diagnosis of prostate cancer and more interested in less invasive surgical approaches
Pentafecta has become a new cornerstone in the analysis of urological surgery results. In this pilot randomized study, we aim to highlight the differences between the standard two-dimensional (2D) with the 4th-generation three-dimensional view (3D) applied to laparoscopic extraperitoneal radical prostatectomy (LERP) in order to assess if the 3D visualization of the operative field could really improve intraoperative and perioperative steps and the pentafecta outcomes
In the 3D LERP group, median Operative time (OT) for the first 3 cases was significantly longer than the remaining cases due to the initial operator learning curve
Summary
Men are younger at the time of diagnosis of prostate cancer and more interested in less invasive surgical approaches (traditional laparoscopy, 3D-laparoscopy, robotics). Erectile function, cancer cure, positive surgical margins and complication are well collected in the pentafecta rate. This study aimed to compare the operative, perioperative data and pentafecta rates between 2D and 3D laparoscopic radical prostatectomy (LRP) and to identify the actual role of 3D LRP in urology. Prostate cancer is the most common tumor in people aged over 50 and is the second leading cause of cancer death in Europe and in the United States. There were recent significant decreases in prostate cancer mortality in Europe and in the United States. Mortality rates have increased in other countries [2,3]. Decreasing mortality rates is mainly due to earlier diagnosis and improved treatment
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