V1233 A MODIFICATION FOR CONTROLLING THE DORSAL VASCULAR COMPLEX IN ENDOSCOPIC EXTRAPERITONEAL RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Oncology1 Apr 2012V1233 A MODIFICATION FOR CONTROLLING THE DORSAL VASCULAR COMPLEX IN ENDOSCOPIC EXTRAPERITONEAL RADICAL PROSTATECTOMY Rens Jacobs, Kevin L.J. Rademakers, Laurent M.C.L. Fossion, and Kevin De Laet Rens JacobsRens Jacobs Veldhoven, Netherlands More articles by this author , Kevin L.J. RademakersKevin L.J. Rademakers Veldhoven, Netherlands More articles by this author , Laurent M.C.L. FossionLaurent M.C.L. Fossion Veldhoven, Netherlands More articles by this author , and Kevin De LaetKevin De Laet Veldhoven, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Controlling the dorsal vascular complex (DVC) in endoscopic extraperitoneal radical prostatectomy (EERPE) by (selective) suture ligation remains a challenging step during apical dissection of the prostate. In this study we report our results of the first 212 cases in which ligation of the DVC was omitted. The aim was to evaluate the consequences of this sutureless transection in terms of blood loss and oncologic control. METHODS Between January 2006 and September 2011 212 patients underwent an EERPE for clinically localized or locally advanced prostate cancer in two different centers. All patients were operated by the same urologist. One hundred and forty-three patients (67.5%) simultaneously underwent an extended laparoscopic pelvic lymph node dissection (LPLND). EERPE was performed according an antegrade manner, as described by Stolzenburg. After complete dissection of the prostate the DVC was selectively divided using bipolar forceps and harmonic scalpel. Blood loss, transfusion need, operative time, pathological stage, margin status and complications were evaluated. RESULTS Mean age of all patients was 64 years (44-74) and mean PSA was 13.2 ng/ml (0.87-190). Mean follow up was 28 months. Mean Gleason score was 6.6. Pathological stage was pT2 in 146 patients (68,9%), pT3 in 63 patients (29,7%), pT4 in 1 patient (0,47%) and pTx in 2 patients (0,94%). Positive margin rates for pT2 and pT3 tumors were 25.3% and 61.9% respectively. Of all positive margins 53.2% was located apically. The mean operative time was 180 min (105-364) for EERPE and 254 min (120-430) for EERPE with LPLND. The median estimated blood loss was 500 ml (50-4000). Six patients (2.8%) had a blood loss more than 2000 ml. Nine patients (4.2%) had a blood transfusion with a mean number of packed cells of 2.9 (1-6). Only one patient needed an extra suture ligation after transection of the DVC. One open conversion was performed due to bleeding from the internal iliac vein during LPLND. CONCLUSIONS Sutureless transection of the DVC in EERPE is a feasible modification and is associated with an acceptable blood loss and oncologic control. It is not associated with a risk for additional complications. Because the 212 patients in this study were part of the surgeon's learning curve even better results are to be expected over time. Functional outcomes of this technique need to be evaluated. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e499 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rens Jacobs Veldhoven, Netherlands More articles by this author Kevin L.J. Rademakers Veldhoven, Netherlands More articles by this author Laurent M.C.L. Fossion Veldhoven, Netherlands More articles by this author Kevin De Laet Veldhoven, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...