Laparoscopic Radical Retropubic Prostatectomy Research Articles

Comparing the efficacy of laparoscopic and open radical prostatectomy: analysis of treatment outcomes in patients with prostate cancer treated in three federal centers

Background. Prostate cancer is currently one of the most challenging problems in urological oncology due to its constantly increasing incidence and mortality in Russia. Surgery remains one of the most radical treatment options for patients with localized and locally advanced prostate cancer of any risk. Multiple studies have compared long-term and functional outcomes of surgeries performed using different surgical approaches. All studies have demonstrated similar long-term and functional outcomes of open, laparoscopic, and robot-assisted surgeries. Objective: to review the existing literature on this problem and analyze outcomes of surgical treatment in patients who had undergone open or laparoscopic prostatectomy in one of three federal centers of the National Medical Research Radiology Center.Materials and methods. This retrospective study included 2,772 patients with localized and locally advanced prostate cancer who had undergone surgery in one of the three federal centers.Results. We evaluated short-term and long-term outcomes of laparoscopic and open radical retropubic prostatectomy (RRP) performed at three federal centers of the National Medical Research Radiology Center. We found that laparoscopic RRP was associated with a longer surgery, lower blood loss, and fewer lymph nodes removed compared to open RRP. Long-term oncological and functional outcomes (prostate-specific antigen relapse-free survival, time to urination recovery) did not significantly differ between patients who had laparoscopic or open RRP.Conclusion. Both open and laparoscopic RRP are equally effective surgical methods for patients with localized and locally advanced prostate cancer.

PJY01 - The experience of robotic camera holder during laparoscopic radical retropubic prostatectomy

PJY01 - The experience of robotic camera holder during laparoscopic radical retropubic prostatectomy

Retropubic, Laparoscopic, or Robotic Radical Prostatectomy: Is There Any Real Difference?

The surgical management of localized prostate cancer has evolved over the last 20 years. The "gold standard" open radical prostatectomy (ORP) has been replaced largely by the robotic-assisted laparoscopic radical retropubic prostatectomy (RALP) as the most common surgical approach to treat localized prostate cancer. Pure laparoscopic radical prostatectomy (LRP), still performed by a limited number of surgeons, was more commonly utilized before the widespread availability of the robotically assisted technique. The general consensus based on the current literature is that RALP is associated with less blood loss and a shorter hospital stay but at a higher cost when compared to ORP. The literature continues to be conflicted concerning outcome measures such as impotence and urinary incontinence. Large series of long-term oncologic follow-up are not yet available; however, the data suggest that oncologic control is similar between RALP and ORP. Considerable disparities in measurement and reporting practices of perioperative outcomes continue to make direct comparisons difficult. Future prospective studies of perioperative outcomes should aim to use rigorous methodology and established criteria for standardized reporting.

Ausgedehnte Salvage-Lymphknotenentfernung aus Becken- und Retroperitoneum bei Prostatakarzinomrezidiv

Treatment of a biochemical prostate cancer relapse represents a difficult clinical dilemma, which has remained without a definitive solution so far. Based on clinical studies, we combine radical prostatectomy with extended pelvic lymph node dissection in intermediate and high risk patients as a routine procedure at our clinic. In this paper, we report on a case of extended salvage lymphadenectomy performed due to biochemical prostate cancer recurrence. The 56-year-old patient came to our clinic in April 2012 with a finding of lymph node metastasis according to PET-CT imaging. Laparoscopic radical retropubic prostatectomy with lymphadenectomy had been performed in 2008 [pT3a, N0 (0/4), M0, R0, GS 5+4=9, iPSA 26.67 ng/mL], and followed by radiotherapy as of September 2009. The extended salvage lymphadenectomy was performed in April 2012 due to a PSA-level rise up to 24 ng/mL and the aforementioned PET-CT findings. A total of 22 lymph nodes were removed, among them 3 lymph nodes with metastases. In the fossa obturatoria on the right we identified a walnut-size lymph node relapse with tumour necrosis, which fully corresponded to the PET-CT scan. The PSA level subsequently dropped to 0.4 ng/mL postoperatively, and further to the current value of 0.02 ng/mL (August 2012).

Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery

We present the initial experience of a novel surgical chair for laparoscopic pelvic surgery, the ETHOS™ (Bridge City Surgical, Portland, OR). The ETHOS chair has an adjustable saddle height that ranges from 0.89 to 1.22 m high, an overall width of 0.89 m, and a depth of 0.97 m. The open straddle is 0.53 m and fits most OR tables. We performed 7 pelvic laparoscopy cases with the 1st generation ETHOS™ platform including 2 laparoscopic ureteral reimplantations, 5 laparoscopic pelvic lymphadenectomies for staging prostate cancer in which one case involved a laparoscopic radical retropubic prostatectomy, performed by 2 different surgeons. All 7 pelvic laparoscopic procedures were successful with the ETHOS™ chair. No conversion to open surgery was necessary. Survey done by surgeons after the procedures revealed minimal stress on back or upper extremities by the surgeons from these operations even when surgery was longer than 120 minutes. Conversely, the surgical assistants still had issues with their positions since they were on either sides of the patient stressing their positions during the procedure. The ETHOS chair system allows the surgeon to operate seated in comfortable position with ergonomic chest, arms, and back supports. These supports minimize surgeon fatigue and discomfort during pelvic laparoscopic procedures even when these procedures are longer than 120 minutes without consequence to the patient safety or detrimental effects to the surgical team.

Ultrasensitive Prostate Specific Antigen Assay Following Laparoscopic Radical Prostatectomy – An Outcome Measure for Defining the Learning Curve

Radical retropubic prostatectomy (RRP) performed laparoscopically is a popular treatment with curative intent for organ-confined prostate cancer. After surgery, prostate specific antigen (PSA) levels drop to low levels which can be measured with ultrasensitive assays. This has been described in the literature for open RRP but not for laparoscopic RRP. This paper describes PSA changes in the first 300 consecutive patients undergoing non-robotic laparoscopic RRP by a single surgeon. To use ultrasensitive PSA (uPSA) assays to measure a PSA nadir in patients having laparoscopic radical prostatectomy below levels recorded by standard assays. The aim was to use uPSA nadir at 3 months' post-prostatectomy as an early surrogate end-point of oncological outcome. In so doing, laparoscopic oncological outcomes could then be compared with published results from other open radical prostatectomy series with similar end-points. Furthermore, this end-point could be used in the assessment of the surgeon's learning curve. Prospective, comprehensive, demographic, clinical, biochemical and operative data were collected from all patients undergoing non-robotic laparoscopic RRP. We present data from the first 300 consecutive patients undergoing laparoscopic RRP by a single surgeon. uPSA was measured every 3 months post surgery. Median follow-up was 29 months (minimum 3 months). The likelihood of reaching a uPSA of < or = 0.01 ng/ml at 3 months is 73% for the first 100 patients. This is statistically lower when compared with 83% (P < 0.05) for the second 100 patients and 80% for the third 100 patients (P < 0.05). Overall, 84% of patients with pT2 disease and 66% patients with pT3 disease had a uPSA of < or = 0.01 ng/ml at 3 months. Pre-operative PSA, PSA density and Gleason score were not correlated with outcome as determined by a uPSA of < or = 0.01 ng/ml at 3 months. Positive margins correlate with outcome as determined by a uPSA of < or = 0.01 ng/ml at 3 months but operative time and tumour volume do not (P < 0.05). Attempt at nerve sparing had no adverse effect on achieving a uPSA of < or = 0.01 ng/ml at 3 months. uPSA can be used as an early end-point in the analysis of oncological outcomes after radical prostatectomy. It is one of many measures that can be used in calculating a surgeon's learning curve for laparoscopic radical prostatectomy and in bench-marking performance. With experience, a surgeon can achieve in excess of an 80% chance of obtaining a uPSA nadir of < or = 0.01 ng/ml at 3 months after laparoscopic RRP for a British population. This is equivalent to most published open series.

Identification and preservation of accessory pudendal vessels during robot-assisted laparoscopic radical retropubic prostatectomy.

The introduction of minimally invasive surgery for radical retropubic prostatectomy has increased the incidence of recognition of accessory pudendal arteries. Early identification and preservation of these vessels is paramount for optimal functional outcomes. In this article, we describe our robotic surgical technique for identification and preservation of both lateral and apical accessory pudendal arteries. The illuminated, magnified surgical field, the pneumoperitoneum which minimizes venous bleeding, and the ability to acutely angle the robotic instruments assists in the preservation of these arteries. Although anatomy precludes the preservation of all accessory pudendal arteries, adopting a strategic approach to robotic dissection allows accessory pudendal arteries to be successfully spared in most cases.

Bladder Neck Contracture after Robot-Assisted Laparoscopic Radical Prostatectomy: Evaluation of Incidence, Risk Factors, and Impact on Urinary Function

Bladder neck contracture (BNC) after radical prostatectomy has been reported to occur in 5% to 32% of men after open radical retropubic prostatectomy (RRP) and 0% to 3% after laparoscopic RRP. Optimal anastomotic closure involves creating a watertight, tension-free anastomosis with well-vascularized, mucosal apposition and correct realignment of the urethra. The cause of BNC is poorly understood; however, it is likely related to multiple factors, including excessive luminal narrowing at the site of reconstruction, local tissue ischemia, failed mucosal apposition, and urinary leakage. In this large series of patients who underwent robot-assisted laparoscopic radical prostatectomy (RLRP), we report the incidence of BNC, evaluate the influence of age, body mass index (BMI), estimated blood loss (EBL), surgical time, and prostate weight on its development and assess follow-up urinary function.Between February 2003 and July 2006, 650 consecutive men underwent RLRP at our institution. Patients with aborted or open conversion procedures were excluded from analysis. The mean overall follow-up for the remaining 634 patients was 19.5 months. Patients presenting with symptoms of outlet obstruction were evaluated with cystoscopy to confirm a BNC. Comparisons of age, BMI, EBL, operative time, and prostate weight were performed using the Student t-test and chi-square analysis.BNC was the diagnosis in seven patients (1.1%), with a mean time of presentation of 4.8 (3-12) months postoperatively. The BNC patients had comparable mean age, BMI, prostate weight, and EBL to the non-BNC cohort. Their operative time, however, was significantly longer (283 v 225 min, P = 0.04).The incidence of BNC after radical prostatectomy is 1.1% in a large series of men undergoing RLRP. The diagnosis was made within 1 year. No significant impact on urinary continence or quality-of-life urinary function was observed after BNC management. A running anastomosis, better visualization, improved instrument maneuverability, and decreased blood loss may account for such a low rate.

1031: Total Surgical Experience, Regardless of Surgical Approach, Predicts Positive Surgical Margins for Skilled Open Surgeons Performing Robotic-Assisted Laparoscopic Radical Retropubic Prostatectomy

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 24, 2005, 8:00 am - 12:00 pm1 Apr 20051031: Total Surgical Experience, Regardless of Surgical Approach, Predicts Positive Surgical Margins for Skilled Open Surgeons Performing Robotic-Assisted Laparoscopic Radical Retropubic Prostatectomy Naveen Kella, Pierre I. Karakiewicz, Thomas M. Wheeler, and Kevin M. Slawin Naveen KellaNaveen Kella More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Thomas M. WheelerThomas M. Wheeler More articles by this author , and Kevin M. SlawinKevin M. Slawin More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35187-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1031: Total Surgical Experience, Regardless of Surgical Approach, Predicts Positive Surgical Margins for Skilled Open Surgeons Performing Robotic-Assisted Laparoscopic Radical Retropubic Prostatectomy." The Journal of Urology, 173(4S), p. 280 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 280 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Naveen Kella More articles by this author Pierre I. Karakiewicz More articles by this author Thomas M. Wheeler More articles by this author Kevin M. Slawin More articles by this author Expand All Advertisement PDF downloadLoading ...

A COMPARISON OF MINIMALLY INVASIVE OPEN AND LAPAROSCOPIC RADICAL RETROPUBIC PROSTATECTOMY

A cohort of more than 1,000 patients undergoing open minimally invasive radical retropubic prostatectomy (mini-lap RRP, 8.0 cm incision) is compared to published series of laparoscopic radical retropubic prostatectomy (RRP). A cohort of 209 consecutive patients undergoing mini-lap RRP at Emory University Hospital was evaluated. Characteristics noted were patient age, comorbidity status, preoperative prostate specific antigen, operative time, perioperative complications, blood transfusions, pathological staging, potency and continence. Postoperative analgesia was analyzed in a cohort of 30 consecutive recent patients. These data were compared to published reports of similar perioperative characteristics in laparoscopic RRP series. Differences between the cohorts of patients reviewed were found in age, preoperative prostate specific antigen, operative time and rate of blood transfusion. The series were comparable in comorbidity status, postoperative complications, rates of incontinence, rates of impotence and margin positivity. Analgesic use was quantified in a small group of patients according to the amount of narcotic analgesia required during the postoperative hospital stay. Mini-lap RRP can generally be performed in less time and at less cost than most laparoscopic radical prostatectomies. It can be performed with regional anesthesia and has excellent postoperative results compared to contemporary laparoscopic procedures. Mini-lap RRP requires less training than laparoscopic RRP. With its minimal morbidity, mini-lap RRP remains an attractive technique that can easily be adopted by the experienced retropubic surgeon.

V1979: Hydrodissection of the Neurovascular Bundles During Laparoscopic Radical Retropubic Prostatectomy: A New Technique

You have accessJournal of UrologyVideo Session, Wednesday, May 12, 2004, 1:30 - 3:30 pm1 Apr 2004V1979: Hydrodissection of the Neurovascular Bundles During Laparoscopic Radical Retropubic Prostatectomy: A New Technique Patricio C. Gargollo, Benjamin C. Lee, Francis J. McGovern, and Douglas M. Dahl Patricio C. GargolloPatricio C. Gargollo More articles by this author , Benjamin C. LeeBenjamin C. Lee More articles by this author , Francis J. McGovernFrancis J. McGovern More articles by this author , and Douglas M. DahlDouglas M. Dahl More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)39220-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "V1979: Hydrodissection of the Neurovascular Bundles During Laparoscopic Radical Retropubic Prostatectomy: A New Technique." The Journal of Urology, 171(4S), p. 522 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 522 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Patricio C. Gargollo More articles by this author Benjamin C. Lee More articles by this author Francis J. McGovern More articles by this author Douglas M. Dahl More articles by this author Expand All Advertisement PDF DownloadLoading ...

V1980: Difficult Problems Encountered During Laparoscopic Radical Retropubic Prostatectomy

V1980: Difficult Problems Encountered During Laparoscopic Radical Retropubic Prostatectomy

Laparoscopic radical retropubic prostatectomy combined with approaches through a small open incision.

The laparoscopic technique is now applied to radical prostatectomy. However, even in laparoscopic prostatectomy, we need a small open wound to remove the prostate from the abdomen. We have developed a modified technique of extraperitoneal laparoscopic radical prostatectomy, exploiting this small open wound as a route for surgical manipulations as well. Here, we described our technique and its initial outcomes. An extraperitoneal retropubic space was developed with finger manipulations through a 3- to 5-cm long suprapubic incision. Three or four trocar ports were set up. A specially designed abdominal wall-lifter was applied to create an endoscopic working space. The surgeons worked using open or endoscopic manipulations through the suprapubic incision or the trocar ports. From October 2000 to August 2001, 11 patients with prostate cancer underwent this surgery. We completed surgery endoscopically without major complications except in one case in which we could not identify a bleeding source. Surgical time ranged from 229 to 469 min. Blood loss ranged from 550 to 3797 ml including urine spilled in the surgical field. Urinary continence returned in 10 cases at 1 to 8 months after surgery. One patient still needed pads at 3 months after surgery. Our technique allowed us to avoid insufflation of the abdomen with gas and intraperitoneal surgical intervention that are disadvantages of conventional laparoscopic prostatectomy, offering the same advantages as conventional laparoscopic prostatectomy.

New method to improve treatment outcomes for radical prostatectomy

Modifications in radical retropubic prostatectomy that use the deep dorsal vein ligator and either anterior urethropexy or puboprostatic ligament preservation were developed to reduce blood loss and improve continence results. Use of the deep dorsal vein ligator to secure the deep dorsal vein complex also improves visualization of the urethra for transection and the neurovascular bundle for nerve sparing and thereby may assist in laparoscopic radical retropubic prostatectomy.

Laparoscopic radical prostatectomy.

Laparoscopic radical retropubic prostatectomy (LRRP) is a new technique for treating organ-confined prostate carcinoma. The procedure was first described and proven to be feasible in 1997. To date, the results from over 150 cases have been reported in the literature. LRRP appears to be an efficacious procedure and deserves careful consideration. However, open radical retropubic prostatectomy (RRP) is routinely performed with excellent results and minimal morbidity. Whether LRRP offers any compelling benefit over open RRP remains to be determined, and will require a systematic comparison of technical advantages, morbidity, and long-term functional outcomes.

Laparoscopic radical prostatectomy: Initial short-term experience

Objectives To determine the feasibility and efficacy of a laparoscopic approach to the radical retropubic prostatectomy (RRP). Methods A transperitoneal laparoscopic technique was developed to perform an RRP. Intra-abdominal access was obtained through five 10-mm trocars. After dissection of the prostate, the urethrovesical anastomosis was created via a transvesical approach. The prostate was removed by extending the umbilical incision. Results Between September 1991 and May 1995, nine laparoscopic RRPs were performed. The operative time averaged 9.4 hours. Only 1 of 9 patients had a positive surgical margin that involved the urethra. Six of 9 patients were completely continent postoperatively. Of the 4 patients who were potent preoperatively, 2 continued to have erections. There were three complications: cholecystitis, thrombophlebitis associated with a pulmonary embolism, and a small bowel hernia into a trocar site. Conclusions Laparoscopic radical prostatectomy is feasible but currently offers no advantage over open surgery with regard to tumor removal, continence, potency, length of stay, convalescence, and cosmetic result.