Extraperitoneal Laparoscopic Radical Prostatectomy: Clinical Experience and Learning Curve with 103 Cases

Abstract

To estimate the early operative results and learning curve of extraperitoneal laparoscopic radical prostatectomy in 103 patients. Between March 2006 and January 2009, 103 patients with clinically organ-confined prostate cancer who underwent laparoscopic radical prostatectomy were enrolled in this study. Surgical morbidity and the oncologic and functional results of the groups were compared to evaluate the learning curve. The patients' mean age was 63.3±8.1 years, and their mean serum PSA was 14.1±7.6 ng/ml. The mean operating time and hospital stay were 265±83 minutes and 10.6±3.6 days, respectively. The mean postoperative period of an indwelling Foley catheter was 13.8±2.7 days. The positive surgical margin rate was 26.2%. After a mean follow-up of 15.5±9.4 months, a PSA relapse was observed in 3 (8.6%) patients in the first period. Continence and sufficient erection rates were about 80% and 45% after 6 months, respectively. Analysis of the learning curve revealed differences in the operating time, estimated blood loss, and complication rate but showed no influence on hospital days, indwelling Foley catheter days, or positive surgical margin rate. Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, morbidity is low and the oncologic continence results were promising. Extraperitoneal laparoscopic radical prostatectomy could be considered as the first safe treatment for patients with organ-confined prostate cancer. The learning curve for extraperitoneal laparoscopic radical prostatectomy seemed to show no complete plateau in this study. It depended not only on technical skills, but also on self-perceived skills. Standardized expectations and operative outcomes could help to define the true learning curve for extraperitoneal laparoscopic radical prostatectomy.