Transperitoneal laparoscopic radical prostatectomy with the Montsouris technique: experience in initial 5 cases

Abstract

In 1998 Guillonneau et al reported feasible and safe technique for laparoscopic radical prostatectomy. Herein we review initial 5 cases with using the Montsouris technique. Between January and April 2000, 5 patients underwent transperitoneal laparoscopic radical prostatectomy. Clinical stages were T1c in 2, T2a in 1 and T2b in 2 patients. Preoperative PSA levels and Gleason grades in needle biopsies ranged from 7.9 to 39 ng/ml and from 2 to 6, respectively. Under general anesthesia 5 to 6 trocars were introduced and the patient was placed in the exaggerated Trendelenburg position. In 2 patients bilateral obturator lymph nodes were dissected for frozen pathological examination. Antegrade prostatectomy was performed initiating with the transperitoneal dissection of seminal vesicles. A watertight vesicourethral anastomosis was made with 8 to 10 interrupted sutures. Operating time and blood loss ranged from 505 to 925 minutes and from 100 to 700 gm, respectively. There were no intraoperative complications and one postoperative complication of prolonged urinary leakage, which was spontaneously closed. In other 4 patients Foley catheters were removed on postoperative day 6 to 10. Laparoscopic radical prostatectomy provides better visualization, inducing meticulous surgical procedures and less blood loss. More sophisticated maneuver would be required in dissection between the prostate and the bladder neck.