Extraperitoneal Laparoscopic Radical Prostatectomy Research Articles

Urinary continence following extraperitoneal radical prostatectomy: impact of surgical technique and pelvic fascial spaces reconstruction

Introduction. Urinary incontinence is a common complication of radical prostatectomy. The development of surgical techniques when performing radical prostatectomy that improve the function of urinary continence after surgery is actual.Objective. To compare urinary continence functions in long-term follow-up after open and laparoscopic radical prostatectomy when only posterior or combined (anterior + posterior) reconstruction of the pelvic fascial spaces is performed.Materials & methods. The study included 130 patients aged 63.0 [59.0; 68.0] years with local prostate cancer (сT1a-2сN0-xM0; 1 – 4 ISUP groups), subjected to non-nerve-sparing retropubic radical prostatectomy with posterior reconstruction and non-nerve-sparing extraperitoneal laparoscopic radical prostatectomy with isolated posterior or combined (anterior + posterior) fascial reconstruction of the pelvic fascial spaces. Postoperative continence function was studied at 1, 3, 6, and 12 months following surgery using a standard pad test.Results. The incidence of urinary continence was higher at all follow-up periods during laparoscopic surgery. From the 6-months follow-up, these patients did not have severe urinary incontinence. At the same time, the rate of growth of some patients who began to retain urine did not depend on the method of reconstruction of the pelvic fascial spaces. The use of combined reconstruction of the pelvic fascial spaces at 12-months follow-up showed an advantage in urinary continence over performing only posterior reconstruction. Such patients achieved urinary continence in 90% of cases compared to 80.0% of cases. At the same time, the restoration of urinary continence at all periods of observation had a relatively uniform linear rate of increase in the indicator.Conclusion. Reconstruction of the pelvic fascial spaces during open and laparoscopic radical prostatectomy allows one to achieve satisfactory continuation in the postoperative period. However, higher efficiency is achieved when using a combined reconstruction technique.

Laparoscopic extraperitoneal radical cystoprostatectomy: for whom and how?

Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G2–G3 muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.Conclusion. Laparoscopic extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.

Comparison of incidence of acute kidney injury after robot-assisted radical prostatectomy with that after open retropubic and extraperitoneal laparoscopic radical prostatectomies in patients with prostate cancer.

We retrospectively evaluated the postoperative renal function in patients who had undergone radical prostatectomy to compare the incidences of postoperative acute kidney injury (AKI) among the patients who had undergone robot-assisted radical prostatectomy (RARP), retropubic radical prostatectomy (RRP), and extraperitoneal laparoscopic radical prostatectomy (exLRP). Patients with prostate cancer who had undergone radical prostatectomy at our institution between 2008 and 2014 were included. Robot-assisted radical prostatectomy was performed using an intraperitoneal approach in a 25-degree Trendelenburg position, whereas other procedures were performed with the patient in the supine position. We evaluated the serum creatinine levels and estimated glomerular filtration rates immediately after surgery and on postoperative day 1. We evaluated the incidence of AKI after prostatectomy using the Acute Kidney Injury Network criteria of the Kidney Disease: Improving Global Outcomes guidelines. A total of 150 consecutive patients were included, with each of the 3 groups (RARP, RRP, and exLRP) comprising 50 patients. Postoperative AKI was observed in 15 (30.0%), 1 (2.0%), and 3 (6.0%) patients in the RARP, RRP, and exLRP groups, respectively. Stage 1 AKI was observed in all the patients except one. The incidence of AKI in RARP group was significantly higher than that in the other groups (p < 0.001). In the RARP group, the serum creatinine level was significantly elevated immediately after the surgery; however, it returned to baseline on postoperative day 1. Surgical procedures were the only independent factor associated with AKI incidence. This study suggest that compared with RRP and exLRP, RARP is associated with a higher incidence of postoperative AKI, although most patients recover rapidly. Intra-abdominal pneumoperitoneum may contribute to AKI onset.

UPGRADING OF LAPAROSCOPIC INTERVENTION OF THE PROSTATE GLAND TUMORS

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

THE VALUE OF METHODS FOR DIAGNOSING ALVEOLAR RHABDOMYOSARCOMA: A CLINICAL CASE

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

THE VALUE OF METHODS FOR DIAGNOSING ALVEOLAR RHABDOMYOSARCOMA: A CLINICAL CASE

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

UPGRADING OF LAPAROSCOPIC INTERVENTION OF THE PROSTATE GLAND TUMORS

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

Comparison of Perioperative, Functional, and Oncological Outcomes of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy.

This study aimed to compare the oncological, functional, and perioperative outcomes of localized and locally advanced prostate cancer treated with intraperitoneal or extraperitoneal laparoscopic radical prostatectomy (LRP). From April, 2008, through December, 2020, 266 patients underwent laparoscopic radical prostatectomy, 168 cases with an extraperitoneal approach (E-LRP) and 98 cases using a transperitoneal approach (T-LRP). The clinical, perioperative, functional, and oncological outcomes were collected and compared between these groups. At the 3-, 12- and 24-monthfollow-ups, the functional outcomes tested were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC). The oncological outcomes of biochemical recurrence, biochemical recurrence-free survival, and positive surgical margin status were evaluated. Univariable and multivariable Cox regression analyses were used to identify factors predictive for biochemical recurrence. All statistical analyses used the R program. The patient characteristics were similar between the E-LRP and T-LRP groups except for higher prostatic-specific antigen (PSA) in the T-LRP group. The T-LRP had lower overall operative time (222.5 min vs. 290 min, p 0.001), decreased blood loss (400 ml vs. 800 ml, p < 0.001), and shorter hospital stays (4 days vs. 7 days, p < 0.001) compared to the E-LRP. Early sexual intercourse with penetration at 3 months was higher in the T-LRP group (36.7% vs. 15.5%, p 0.001). Urinary continence (no pads) was not different between the T-LRP and E-LRP groups at 3 and 24 months after surgery but higher in the E-LRP group at 12 months (1% vs. 3%; p=0.419, 85.1 vs. 83.7%; p=0.889, 47.4% vs. 34.6%; p=0.028, respectively). The EPIC questionnaire was used to assess functional outcomes at 3, 12, and 24 months after surgery and found that urinary function was significantly higher in the T-LRP group at 3 and 12 months (p < 0.001) but did not show a difference at 24 months (p=0.734), and sexual function scores were higher in the T-LRP group at 12 and 24 months (p=0.001). The positive surgical margin rate was higher in the E-LRP (38.7% vs. 21.4%; p=0.006). The BCR rate was not different between the groups (36.3% in the E-LRP group and 27.6% in the E-LRP group; p=0.184). Transperitoneal laparoscopic radical prostatectomy (T-LRP) was found to be superior to extraperitoneal radical prostatectomy (E-LRP) in perioperative outcomes such as decreased operative time, decreased blood loss, shorter hospital stay, lower positive surgical margin, and improved early sexual intercourse and sexual function. The urinary functional outcome was better in the T-LRP group at 3 and 12 months. These findings support the use of transperitoneal laparoscopic radical prostatectomy, as our study patients exhibited significant benefits from this procedure.

Effect of modified extraperitoneal laparoscopic total intrafascial radical prostatectomy on clinical efficacy for prostate cancer patients

The effective surgical treatments of localized prostate cancer patients were explored. 90 prostate cancer patients admitted to our hospital were selected as study subjects. They were divided into research (treated by modified extraperitoneal total intrafascial laparoscopic radical prostatectomy) and control (treated by extraperitoneal laparoscopic radical prostatectomy) groups by random number table method, having 45 cases each. The operation time, bleeding volume, drainage time, hospitalization time, vascular endothelial stimulation index, urinary control function, erectile function, complications, and recurrence were monitored and compared. No significant difference was found between the two groups in clinical operation related indexes. On 3rd and 7th days after operation, VEGF (Vascular Endothelial Growth Factor) and IGF-I (Insulin-like Growth Factor 1) in research group were lower than those in control (p &lt; 0.005). The urine control rate and erectile function normal rate in research group were higher than those in control (p &lt; 0.005). Modified extraperitoneal laparoscopic total intrafascial radical prostatectomy reduced the degrees of trauma and irritation in the operation of prostate cancer patients. Moreover, during the observation period, it improved the postoperative urinary control and erectile function of patients and reduced the complications. Thus, this method has the worth of clinical promotion and application.

P043 - Extraperitoneal laparoscopic radical prostatectomy in renal transplant recipients. Is it an effective technique?

P043 - Extraperitoneal laparoscopic radical prostatectomy in renal transplant recipients. Is it an effective technique?

UP04 - Impact of nerve-sparing surgical technique during 3 trocars extraperitoneal laparoscopic radical prostatectomy: What we learned after consecutive 704 cases

UP04 - Impact of nerve-sparing surgical technique during 3 trocars extraperitoneal laparoscopic radical prostatectomy: What we learned after consecutive 704 cases

Functional and perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy versus transperitoneal in university-based hospital

Background: We aim to compare perioperative and postoperative outcomes between extraperitoneal (ELRP) and transperitoneal laparoscopic radical prostatectomy (TLRP) in localized prostate cancer using retrospective patient reported-outcome measures of functional and perioperative outcomes.

Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience.

To present a retrospective analysis on the oncological and functional outcomes of a single-center experience on a large series of extraperitoneal laparoscopic radical prostatectomies (eLRP) with an extended follow-up. Herein we present a retrospective review of patients who underwent eLRP. Oncological and functional follow-up data were collected by means of outpatient visits and telephone interviews, assessing overall mortality and biochemical recurrence-free survival. Patients with clinical T4 stage prostate cancer (PCa), previous surgery for benign prostatic hyperplasia (BPH), previous androgen deprivation, radiotherapy, concomitant chemotherapy and/or experimental therapies, and with insufficient follow-up data were excluded. Preoperative data recorded were age, body mass index, ultrasound prostate volume, preoperative PSA and clinical stage of PCa. Operative data (operative time, nerve sparing technique and any perioperative complication) and pathological findings were obtained by consulting the surgical and pathological reports. Oncological and functional follow-up were collected during follow-up visits and telephone interview. Between January 2001 and December 2019, overall 938 eLRP were performed at our Institution. The median follow-up was 132 months. 69.7% of the patients had complete dataset. The estimated overall biochemical recurrence (BCR)-free survival was 71.4% at 5 years and 58.9% at 10 years. Cancer specific survival was 84,5%. Erectile function was preserved in the most of patients as postoperative IIEF-5 score within 12 months after surgery was > 12 in the 82.1%. About the urinary incontinence, 0.76% of the patients presented severe incontinence (continued and persistent loss of urine) and 7.0% were mildly incontinent (using up to one pad per day). Conclusions; eLRP has shown oncological and functional results comparable to other minimally invasive techniques and to open radical prostatectomy (ORP), with favorable perioperative outcomes than the open technique and a reduced complication rate.

Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

IntroductionRectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140–210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30–60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Extraperitoneal Laparoscopic Versus Transperitoneal Robot-Assisted Laparoscopic Approaches for Extended Pelvic Lymph Node Dissection During Radical Prostatectomy.

Background: We aim to directly compare the feasibility and safety of extended pelvic lymph node dissection (PLND) during transperitoneal robotic-assisted radical prostatectomy (Tp-RARP) and extraperitoneal laparoscopic radical prostatectomy (Ep-LRP). Materials and Methods: We retrospectively identified the prospectively maintained database records of 162 patients diagnosed with prostate cancer (PC) who underwent Ep-LRP or Tp-RARP with extended PLND. Patients with risk of nodal metastases over 5% according to Briganti nomogram received extended PLND. All data analyzed in this study were based on the documentation in our PC database including age, body mass index, Charlson comorbidity index score, preoperative prostate-specific antigen, history of abdominal surgery, biopsy Gleason score, total operation time, postoperative pelvic drainage time, pathological results, lymph node yield (LNY), percentage lymph node involvement (%LNI), and perioperative complications. Patients were followed up for biochemical recurrence in the postoperative period. Results: Eighty-two of the 162 enrolled patients were in group 1 (Ep-LRP+PLND) and 80 were in group 2 (Tp-RARP+PLND). There were no statistically significant differences between the groups regarding preoperative demographics and clinical characteristics. The median LNY was 17 (range 8-27) and 17.5 (range 10-29) in groups 1 and 2, respectively, and no statistically significant difference was found. There was no significant difference between the groups in terms of biochemical recurrence-free survival with mean follow-up of 44.8 months after radical surgery. Conclusion: Our results support the view that extended PLND through the Ep-LRP approach is a feasible and safe procedure without compromising oncological efficacy compared with a similar template attempted during Tp-RARP. Clinical Trial Registration number is 01/21-2.

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal

IntroductionRectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Functional and Perioperative Outcomes of Extraperitoneal Laparoscopic Radical Prostatectomy versus Transperitoneal in University-Based Hospital

Functional and Perioperative Outcomes of Extraperitoneal Laparoscopic Radical Prostatectomy versus Transperitoneal in University-Based Hospital

Beforehand transection and suturing (BTS) of the dorsal vascular complex: a novel technique in laparoscopic radical prostatectomy.

Beforehand transection and suturing (BTS) of the dorsal vascular complex (DVC), a novel technique in non-neurovascular bundle sparing (NVB-sparing) extraperitoneal laparoscopic radical prostatectomy (eLRP), had been proposed; this study aimed to evaluate this technique in clinical laparoscopic procedures. Using this new technique, the DVC was transected and sutured after dissection of the pelvic fascia and before dissection of the prostate, especially before ligation of the bilateral prostatic pedicles. This study retrospectively analyzed the data of 90 non NVB-sparing eLRP patients [traditional technique (n=60) and BTS technique (n=30)]. The surgical time in the BTS technique group was 121.73±24.53 min, which was significantly shorter (P=0.0015) than the traditional technique group (144.12±39.68 min). The calculated blood loss in the traditional technique group was 388.45±232.78 mL, and 264.16±130.70 mL in the BTS technique group (P=0.0016). The estimated blood loss in the traditional technique group was 350.34±311.80 mL, which was significantly greater than the BTS technique group (250.33±145.31 mL, P=0.0422). The transfusion rate in the traditional technique group was significantly greater than the BTS technique group (15.00% vs. 0.00%; P=0.0266). The biochemical recurrence rate in traditional technique group was 48.33%, which was higher than in the BTS group (30.00%) (P=0.0465). There was no significant difference between the 2 groups with respect to the pre-operative hemoglobin (Hb) concentration, pre-operative hematocrit (HCT), post-operative Hb concentration, post-operative HCT, ΔHCT, pre-operative blood volume, rectal perforation, open conversion, apical capsule residue, false suture, post-operative bleeding, urinary leakage, re-operation, surgical site infection, post-operative stay, and emission time of urinary incontinence. In managing the relationship between the DVC and prostate in patients undergoing non NVB-sparing eLRP, the BTS technique was shown to be more effective and safer than the traditional technique.

The application and outcomes of C. R.P.C. four-step radical prostatectomy under extraperitoneal laparoscopy

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C. four-step) for localized prostate cancer and the outcomes based on early follow-up. Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b, with average age of (67±5) years old, average preoperative total PSA value of (45.32±18.33) ng/ml, and average prostate volume was (42±12)cm3. All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique, abbreviating as C. R.P.C.[C: control DVC (dorsal deep venous complex). R: recognize three anatomical layers (prostate and bladder junction, seminal vesicle, and Denonvilliers’fascia surface). P: preserve urethral sphincter and bladder neck. C: continuous anastomosis between urethra and bladder neck (4 key needles at 3, 5, 7 and 9 o’clock)]. The operative time, estimated blood loss, length of hospital stay and postoperative complications were recorded, and the postoperative PSA was followed up. Results All the 102 cases were successfully treated by laparoscopic radical prostatectomy. The operative time was from 55 to 156 min (mean 92 min), and the estimated blood loss was from 55 to 185 ml (mean 105 ml). There was no case converted of open surgery, only one case received blood transfusion for postoperative hemorrhage (0.98%), and positive surgical margin was found in 15 case (14.70%) by pathological examination. Postoperative urinary extravasation within one week occurred in 2 (1.96%) cases, and resolved after tensioning the catheter and prolonging the indwelling time. During the follow-up period of 12 to 45 months, 2 cases were incontinent (grade Ⅰ-Ⅱ), and the other cases(98.04%) had no incontinence or dysuria . However, 11 cases(10.78%) developed to biochemical recurrence within 6 months after the operation. Conclusions The C. R.P.C. four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists, and was efficient and safe. Key words: Prostatic neoplasms; Radical prostatectomy; Extraperitoneal laparoscopy; Prostate cancer; Four-step method; Curative effect

Extended pelvic lymph node dissection during extraperitoneal laparoscopic or robotic assisted radical prostatectomy

Objective: Extraperitoneal access in endoscopic (laparoscopicic or robotic assisted) radical prostatectomy is a standard approach in the management of prostatic cancer with well-established advantages over transperitoneal access. Still, traditionally, extraperitoneal endoscopic radical prostatectomy (EERP) has been associated with an inability to offer an extended pelvic lymph node dissection (PLND). The former is due to the fact that in the extraperitoneal space, peritoneal folding covers the majority of common iliac vessels and as a result in extraperitoneal PLND, lymph nodes (LNs) located above the bifurcation of common iliac vessels cannot be dissected. We herein present a simple and easy technique to offer an extended PLND during EERP. Methods: After a conventional extraperitoneal PLND, a peritoneal fenestration cranially to extrernal iliac vessels is performed bilaterally exposing the common iliac vessels. Results: Upon peritoneal fenestration, PLND can be continued in a standard fashion as in transperitoneal approach until the uppermost limit of the extended PLND template which is the ureteral crossing over common iliac vessels. Following LN dissection, both peritoneal fenestrations are left open at both sides, as this approach has been found to decrease the incidence of postoperative lymphocele formation. Conclusions: Peritoneal fenestration over common iliac vessels during extraperitoneal PLND is an easy approach that allows surgeon to reach the uppermost limit of extended PLND template. The latter peritoneal dissection is not time consuming and is expected to decrease the morbidity of the operation reducing the incidence of postoperative lymphocele formation.