Transperitoneal Laparoscopic Radical Prostatectomy Research Articles

A Randomized Controlled Study of Robot-Assisted versus 3D Laparoscopic Radical Prostatectomy in Patients with Carcinoma Prostate.

A prospective randomized comparative study was performed from 1st January 2020 to 30th June 2021. All patients included were diagnosed with localized/locally advanced ca prostate. 60 patients fulfilling the inclusion and exclusion criteria were randomized into 2 groups. Groups A and B included patients who underwent robot-assisted radical prostatectomy and 3D laparoscopic transperitoneal radical prostatectomy, respectively. Various demographic, intraoperative, postoperative, and follow-up parameters were collected. Outcomes were evaluated in the form of the trifecta (continence, potency, and BCR-free status) and pentafecta rates (trifecta with no perioperative complications and negative surgical margins) in between the two groups. The mean operative time in Group A was 137.83 mins ± 17.27 compared to 148.20 mins ± 26.16 in Group B. Trifecta rates in Group A and Group B were 43.3%, 63.3%, and 76.6% and 40%, 53.3%, and 70% at 1, 3, and 6 months. Pentafecta rates in Group A and Group B were 36.6%, 53.3%, and 70% and 33.3%, 40%, and 53.3% at 1, 3, and 6 months. Complication rates were 10% in Group A and 13.3% in Group B, respectively. Only one patient in our study (Group B) had a positive surgical margin. We conclude from our comparative study, that both robot-assisted and 3D laparoscopic transperitoneal radical prostatectomy are feasible and efficacious treatment modalities for achieving acceptable trifecta and pentafecta rates in managing ca prostate with earlier continence and shorter urethrovesical anastomosis time in the robotic arm.

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.

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.

Comparison of enhanced recovery after surgery protocol and conventional approach after laparoscopic transperitoneal radical prostatectomy: a retrospective analysis

BackgroundAlthough open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy.MethodsThere is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups.ResultsThe mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer.ConclusionIn summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.

Robotic-assisted perineal versus transperitoneal radical prostatectomy: A matched-pair analysis.

We compared the outcomes of robotic-assisted radical perineal prostatectomy (r-PRP) versus robotic-assisted transperitoneal laparoscopic radical prostatectomy (RARP). Between November 2016 and September 2017 in our center, 40 patients underwent r-PRP, and 40 patients underwent RARP. All patients also underwent multiparametric magnetic resonance imaging (mpMRI) to exclude the cases with locally advanced disease. Patients with localized prostate cancer (C-T2N0M0) were included in the study. The exclusion criteria were contraindications for undergoing robotic radical prostatectomy; the Gleason score ≥4+3; extracapsular extension proven on biopsy or suspected on mpMRI; clinical stage ≥T2c; required pelvic lymph dissection according to Partin's normogram; previous radiation therapy; hormonal therapy; any previous prostatic, urethral, or bladder neck surgery; and preoperative urinary incontinence or erectile dysfunction. Patients were placed in the exaggerated lithotomy position with 15° Trendelenburg for r-PRP and 40° Trendelenburg for RARP. The mean age for the r-PRP and RARP groups were 61.2 (46-73) and 62.2 (50-75) years, respectively. The mean body mass index was significantly higher in the r-PRP group (p=0.02). The mean procedure duration time was 169.4 (100-255) minutes for the r-PRP group and 173.1 (130-210) minutes for the RARP group. The mean console time and anastomosis time were significantly lower for the r-PRP group. The mean estimated blood loss was significantly lower for the r-PRP group (p=0.002). Immediate continence rates in the r-PRP and RARP groups following the urethral catheter removal were 42% and 35% (p=0.30), respectively. Continence rates increased to 94.2% in the r-PRP and 72% in RARP (p=0.001) group at the 6th month, and to 95% in the r-PRP and 85.2% in RARP (p=0.02) group at the 9th month follow-up period. According to the International Index of Erectile Function-5 (IIEF-5), the erectile function rates at the 3-, 6-, and 9-month follow-up in the r-PRP group were 44%, 66%, and 75%, respectively. The rates in the RARP group at the 3-, 6-, and 9-month follow-up were 25%, 42%, and 66% (p=0.001), respectively. In our experience, r-PRP has acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results compared to RARP.

The Association of Shorter Interval of Biopsy-Radical Prostatectomy and Surgical Difficulty.

We discuss the safety and perioperative outcomes of a 2-week interval between prostate biopsy and laparoscopic radical prostatectomy (LRP). We retrospectively reviewed the medical records of 182 patients with prostate cancer (PCa) who underwent transperitoneal LRP 2 weeks after prostate biopsy between 2012 and 2015. We evaluated the following perioperative outcomes: operative time, estimated blood loss (EBL), infection, conversion to open surgery, positive surgery margins (PSM), and complications. We also reviewed studies discussing a shorter interval between biopsy and LRP in peer-reviewed publications. The mean operative time and EBL were 100.2 min and 82.2 ml, respectively. There were no rectal injuries or conversions to open surgery, totally 19 (10.4%) patients experienced complications (Clavien-Dindo Grade I and II): fever occurred in six patients (3.3%), urinary leak in four (2.2%), incomplete paralytic ileus in four (2.2%), deep vein thrombosis in two (1.1%), and postoperative anemia in four. The average bedrest time after surgery was 2.5 days. PSM was detected in twenty-one patients (11.5%) . 167 patients (91.7%) recovered continence.Follow-up ranged from 13-37 months, the biochemical recurrence (BCR) rate was 10.4% (19/182).The seven peer-reviewed studies we reviewed that a shorter interval was safe and did not influence surgical outcomes. Our study shows that a 2-week interval between biopsy and LRP is safe and does not negatively affect surgical outcomes.

[SIGNIFICANT, TRANSIENT VISUAL DISTURBANCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY].

Visual disturbance following non-ophthalmologic surgery under general anesthesia is rare but can be devastating both socially and medicolegally. Immediate salvage intervention as well as prevention is of utmost importance since this can be a serious blow to patient's functional outcome postoperatively. We experienced a case of temporary but significant visual disturbance right after transperitoneal laparoscopic radical prostatectomy for localized prostate cancer. We need to raise our levels of vigilance to this condition since it can be avoided and prevented with immediate therapeutic intervention and decent clinical awareness.

Transperitoneal versus extraperitoneal approach in laparoscopic radical prostatectomy: A meta-analysis.

Background:To compare the transperitoneal approach with extraperitoneal approach in laparoscopic radical prostatectomy (LRP) (including pure and robotic-assisted LRP) using meta-analytic techniques.Methods:Medline (PubMed), Embase, Ovid, CMB, and Cochrane databases were searched for studies that compared the transperitoneal and extraperitoneal approaches in LRP from January 2000 to January 2017. Outcomes included were operative time, operative bloods joss (milliliters), rate of transfusion, rate of open conversion, rate of intraoperative complications, rate of postoperative complications, and time of postoperative catheterization.Results:Thirteen studies including 1674 patients were selected for the meta-analysis. 850 (50.8%) cases had undergone transperitoneal LRP (TLRP) and 824 (49.2%) cases had undergone the extraperitoneal LRP (ELRP). Comparison of operative time between the TLRP group and the ELRP group showed no significant differences (weighted mean difference [WMD] = 21.21,95%CI = –1.16–43.57, P = .06). No significant differences were observed in blood loss (WMD = −6.04, 95%CI = −43.38–31.29, P = .75) and the rate of transfusion (odds ratio [OR] = 1.03, 95%CI = 0.55–1.96, P = .92) between the 2 groups. No significant differences were observed for the rate of intraoperative complications (OR = 1.25, 95%CI = 0.57–2.21, P = .75) and the rate of open conversion (OR = 1.12, 95%CI = 0.32–4.97, P = .75). Significant differences were observed in the TLRP group compared with the ELRP group (OR = 1.69, 95%CI: 1.23–2.32, P = .001) regarding the rate of postoperative complications.Conclusions:Our meta-analysis findings revealed that the TLRP group showed no significant differences in most important indicators compared with ELRP. Moreover, TLRP showed higher rate of postoperative complications compared with ELRP.

Retzius space reconstruction following transperitoneal laparoscopic robot-assisted radical prostatectomy: does it have any added value?

Retzius space sparing (RSS) during laparoscopic robot-assisted radical prostatectomy (RALP) has been offered as an approach that reduces perioperative complications and enables faster gaining of full urinary continence due to bladder anatomy preservation. Retro and transperitoneal techniques have been proposed, whereby RSS has been implemented. We sought to explore whether Retzius space reconstruction (RSR) following transperitoneal RALP will be an advantageous step as well. A prospective registry database of 102 consecutive transperitoneal RALP cases performed by a single surgeon was reviewed. The Retzius space had been opened by dissecting the bladder away from the anterior abdominal wall to the level of both internal rings. In the last 51 cases (RSR group), the peritoneal layer had been sutured back, thus repositioning the bladder back to the anterior abdominal wall and reconstructing the Retzius space. Perioperative factors were analyzed and compared between the two groups. Demographic and perioperative data did not differ between the two groups. RSR group demonstrated shorter length of stay (LOS) compared with the control group (p=0.01), as well as faster urinary continence recovery (i.e., 0 pads) (p=0.01). Moreover, lower numbers of Clavien-Dindo class 3 complications and 12mm port-site hernias (p=0.03) were seen in the RSR group compared with the control group. RSR following transperitoneal RALP is a simple and efficient step that potentially reduces early and late post-operative complications, shortens LOS and accelerates full urinary continence.

A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience.

A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience.

MP69-02 COMPARISON OF TWO TEMPLATES OF LYMPHADENECTOMY IN PATIENTS WITH HIGH RISK PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2016MP69-02 COMPARISON OF TWO TEMPLATES OF LYMPHADENECTOMY IN PATIENTS WITH HIGH RISK PROSTATE CANCER Roberto Sanseverino, Tommaso Realfonso, Olivier Intilla, Umberto Di Mauro, and Giorgio Napodano Roberto SanseverinoRoberto Sanseverino More articles by this author , Tommaso RealfonsoTommaso Realfonso More articles by this author , Olivier IntillaOlivier Intilla More articles by this author , Umberto Di MauroUmberto Di Mauro More articles by this author , and Giorgio NapodanoGiorgio Napodano More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1380AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High risk prostate cancer treatment considers an extended lymphadenectomy. We have compared two templates of pelvic lymphadenectomy in high risk patients undergone an extraperitoneal or transperitoneal laparoscopic radical prostatectomy. METHODS Two consecutive series of patients affected by high risk prostate cancer underwent laparoscopic radical prostatectomy. In group 1 (101 pts), the procedure was realized by a preperitoneal access with an extended lymphadenectomy including external iliac and obturator nodes; in group 2 (25 pts), access was transperitoneal with a broader lymphadenectomy consisting of common iliac, external iliac, hypogastric and obturator nodes. We have compared perioperative outcomes in terms of number of nodes removed, positive nodes, complications in the two groups of patients. Statistical analysis has been realized using SPSS 16 RESULTS Data on 126 patients were analyzed. Baseline characteristics are reported in table 1. Preoperative data were balanced between two groups of patients except for biopsy Gleason score. Postoperative outcomes are listed in table 2: Group 2 patients presented worse pathological stage, longer operative time, more nodes removed (mean 31.6 vs 15.9, p<0.001) and more positive pathological nodes (28.0 vs 1.9%, p<0.001). Moreover, a wider lymphadenectomy template was not associated to greater risk of complications or lymphocele. CONCLUSIONS In our retrospective analysis, a transperitoneal laparoscopic radical prostatectomy with an extended lymphadenectomy template including obturator, external iliac, common iliac and hypogastric nodes allows to remove a greater number of nodes, to obtain a more positive nodes without increasing risk of complications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e898 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Roberto Sanseverino More articles by this author Tommaso Realfonso More articles by this author Olivier Intilla More articles by this author Umberto Di Mauro More articles by this author Giorgio Napodano More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of robot assistant radical prostatectomy by transperitoneal versus extraperitoneal approach

Objective To compare the safety and oncological results of robot-assisted laparoscopic radical prostatectomy performed between transperitoneal and extraperitoneal approach. Methods 79 patients underwent transperitoneal robot-assisted laparoscopic radical prostatectomy(Tp-RLRP). The other 86 consecutive patients went through extraperitoneal robot-assisted laparoscopic radical prostatectomy(Ep-RLRP). Results All procedures were performed successfully without conversion. Total procedure time for Ep-RLRP was shorter than it for Tp-RLRP[(218.1±54.4) min vs.(180.2±47.1)min, P<0.001]. Docking time for Ep-RLRP was longer than Tp-RLRP[(21.5±7.1)min vs.(19.5±5.7)min, P<0.001]. Blood lost of Tp-RLRP was lesser than Ep-RLRP[(122.4±71.0)ml vs.(140.4±90.7)ml, P<0.05]. There were no significant differences between two groups in terms of bowel function recovery, drainage tube reserve, foley catheter duration, etc. There were 19 patients(24.1%)and 4 patients(4.7%)were suffered lymph leakage in two groups separately, P<0.001. One delayed vesiclurethra hemorrhagic patient and one mesenteric torsion patient were happened in Tp-RLRP group. There were no significant differences between two groups in terms of surgical margin, biochemical recurrence and urine continence. Conclusion Compared to Tp-RLRP, Ep-RLRP can provide similar short-term oncological control, recovery of postoperative urine continence, shorter operation time and lower complication rates. Key words: Robotics; Prostate cancer; Prostatectomy

Comparative study of transperitoneal laparoscopic radical prostatectomy and open radical prostatectomy

Objective To compare the clinical efficacy and safety of transperitoneal laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP) for treatment of localized prostate cancer. Methods From March 2003 to December 2014, 395 consecutive cases of radical prostatectomy were retrospectively analyzed. The patients were divided into 2 groups: LRP group with 325 cases and ORP group with 70 cases. There were no significant differences in age (P=0.364), body mass index (P=0.360), preoperative PSA level (P=0.076), preoperative Gleason score (P=0.839) and prostate volume (P=0.241) between LRP group and ORP group. Therapeutic effect was compared between the 2 groups. Results The differences of operative time (LRP: 114±29 min, ORP: 150±39 min, P=0.002), blood loss (248±96, 569±166 ml, P<0.001), intestinal function recovery time (2.2±0.9, 3.0±0.8 d, P=0.031), postoperative hospital stay (7.1±1.4, 8.9±1.6 d, P=0.028) and complication rate(P<0.001) were significantly between the 2 groups. There were no significant differences in positive surgical margin rate(P=0.397) and 1–year or 2–year biochemical recurrence rate (P=0.664, P=0.238) between the 2 groups. Conclusion In the present cohort, compared with open surgery, LRP had advantages of fewer traumas, quicker recovery and fewer complications, while the tumor control was similar. Key words: Prostatic neoplasms; Laparoscopes; Radical prostatectomy; Open surgery; Treatment outcome

S200 Comparison of operative, pathologic and continence results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy: Single surgeon experience

S200 Comparison of operative, pathologic and continence results of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy: Single surgeon experience

Trocar-site hernia at the 8-mm robotic port after robot-assisted laparoscopic prostatectomy: a case report and review of the literature.

Trocar-site hernia is an uncommon but serious complication after laparoscopic surgery as it frequently requires surgical intervention. We describe a 75-year-old man with Gleason score 4+3, clinical stage T1c prostate adenocarcinoma who underwent an uneventful robot-assisted transperitoneal laparoscopic radical prostatectomy. On post-operative day four, he developed symptoms of small bowel obstruction due to herniation and incarceration of the small bowels in a Spigelian-type hernia at the left lower quadrant 8-mm trocar site. Surgical exploration was performed via a mini-laparotomy to reduce the bowel and repair the fascial layers. A literature search was performed to review other cases of trocar-site hernia through the 8-mm robotic port after robot-assisted surgery and the suggested methods of prevention.

Modified transperitoneal laparoscopic radical prostatectomy : clinical study of 285 cases

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 285 patients received the operation with mean age of 67 years (50-76 years) from January 2008 to April 2012.Mean level of PSA was 15.7 μg/L (1.8 -50.0 μg/L),and mean prostatic volume was 44 ml (26 -74 ml). No lymph node or seminal vesicle involvement was found by CT or MR and radionuclide bone scan revealed no metastasis.271 cases were confirmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP specimens.Gleason score ranged from 6 to 8.14 cases were in clinical stage T1b,29 cases in T1c,214 cases in T2 and 28 cases in T3a.Transperitoneal approach and modified technique involving bladder neck dissection,nervesparing technique and vesicoureteral anastomosis were applied on patients. Results Mean operative time was 105 min (55 -150 min).Mean intraoperative estimated blood loss was 240 ml (50-800 ml).Rectal injures occurred in 2 cases and were repaired under laparoscopy.Drainage tube and urinary catheter were removed 48 -72 h and 5 -8 d postoperatively.Postoperative hospital stay was 7 d (5 - 11 d).Positive surgical margin was present in 58 patients.Mean follow-up time was 29 months (3 -50 months).Complete continence were found in 208 patients immediately after catheter removal.68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 42 of the 57 cases with nerve-sparing. Conclusions Transperitoneal laparoscopic radical prostatectomy is safe and efficient.Higher efficiency and lower complication rate have been achieved through modified laparoscopic technique involving bladder neck dissection,nerve-sparing technique and vesicoureteral anastomosis. Key words: Prostatic neoplasms; Laparoscopy; Transperitoneal approach; Radical prostatectomy

Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE): technique and outcome

Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure's established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.

V1566 THE YORK-MASON TECHNIQUE FOR REPAIR OF RECTO-URINARY FISTULAS AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyInfertility, Infection, Erectile Dysfunction & Trauma1 Apr 2011V1566 THE YORK-MASON TECHNIQUE FOR REPAIR OF RECTO-URINARY FISTULAS AFTER RADICAL PROSTATECTOMY Enrique Rijo, Jose A. Lorente, Oscar Bielsa, Miguel Pera, Albert Frances, and Octavio Arango Enrique RijoEnrique Rijo Barcelona, Spain More articles by this author , Jose A. LorenteJose A. Lorente Barcelona, Spain More articles by this author , Oscar BielsaOscar Bielsa Barcelona, Spain More articles by this author , Miguel PeraMiguel Pera Barcelona, Spain More articles by this author , Albert FrancesAlbert Frances Barcelona, Spain More articles by this author , and Octavio ArangoOctavio Arango Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The recto-urinary fistula is a rare complication following treatment for prostate cancer (surgery, ablative and ionizing therapies) or pelvic traumas. The reported incidence after radical prostatectomy is 0.4–1.8%. Spontaneous resolution rarely occurs and many reconstructive procedures have been proposed. Successful repair is often difficult. We report our experience with the trans-sphincteric-transrectal approach (York-Mason Technique) for rectourinary fistula repair after radical prostatectomy. METHODS Between September 2002 and July 2010, a repair of rectourinary fistulas with the posterior York-Mason approach was performed on 12 patients in our institution. The fistula repair was carried out between 5 and 10 months months after diagnosis. All patients had a pre-operative voiding cystogram, and cystoscopy which documented the recto-urinay fistula. A loop ileostomy was performed on 6 patients at the time of definitive surgical repair, whereas an initial fecal diversion with a sigmoid loop colostomy was performed in 4 other cases. Here follows the details of one such case. Case report: A 56-year-old male patient presented with adenocarcinoma of the prostate gland pT1cNxMx stage, Gleason score 7 (3+4). The patient had undergone a non-nerve sparing laparoscopic transperitoneal radical prostatectomy. A rectal injury occurred during surgery and was repaired primarily. Eight days postoperatively, the patient experienced fecaluria and pneumaturia. Radiographic and endoscopic evaluation supported the diagnosis of a recto-vesical-fistula and localized the defect. Initial management included an indwelling urethral catheter without fecal diversion. The fistula failed to close and the patient was referred to our center for corrective surgery. At five months, a York-Mason repair of the fistula was performed. Initial fecal diversion with a sigmoid loop colostomy was performed at the time of surgical repair. This video describes the York-Mason repair surgical technique step-by-step. RESULTS Successful fistula closure was achieved in all cases with complete fecal continence. No recurrence was observed after a mean follow-up of 46 (4–90) months. CONCLUSIONS The York Mason Technique provides easy identification of recto-urinary fistulas and excellent surgical exposure with minimal postoperative morbidity and no impairment of continence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e628 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enrique Rijo Barcelona, Spain More articles by this author Jose A. Lorente Barcelona, Spain More articles by this author Oscar Bielsa Barcelona, Spain More articles by this author Miguel Pera Barcelona, Spain More articles by this author Albert Frances Barcelona, Spain More articles by this author Octavio Arango Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Incidence and Risk Factors for Inguinal and Incisional Hernia After Laparoscopic Radical Prostatectomy

To examine the risk of postoperative hernia development in men undergoing transperitoneal and extraperitoneal laparoscopic radical prostatectomy (LRP). Open radical retropubic prostatectomy increases the risk of postoperative inguinal hernia development within the first 2 postoperative years. It is less clear to what extent minimally invasive radical prostatectomy techniques affect the incidence of hernia development. A total of 651 LRP patients were mailed follow-up surveys regarding hernia development. Of these 651 patients, 378 responded (58%). Of the 378 patients, 308 had complete medical records for review. The mean follow-up for the fully evaluable cohort was 33.9 months (median 29.5, range 3-87). The potential risk factors for hernia (ie, previous hernia, age, surgical approach, pelvic lymph node dissection, bladder neck contracture, and operative time) were evaluated as categorical and/or continuous variables and using the univariate Cox proportional hazard ratio and Kaplan-Meier analyses. Preoperatively diagnosed inguinal hernias were repaired laparoscopically at LRP. The incidence of postoperative inguinal hernia was 5.2% (16 of 308). After transperitoneal LRP (n = 122), 7.4% (9/122) reported an inguinal hernia, a few (29%) of which occurred within 2 years after LRP. After extraperitoneal LRP (n = 186), only 3.8% (7/186) reported an inguinal hernia, all of which occurred within 2 years after LRP. Kaplan-Meier analysis, however, demonstrated no effect of the surgical approach on the inguinal hernia incidence (P = .65). No risk factor was significantly associated with the postoperative hernia risk. One incisional hernia was noted (0.3%, 1 of 308), at a 5-mm extraperitoneal port site. Of the 308 men in the present study, 21 (6.8%) had undergone synchronous hernia repair, with no recurrences. The incidence of inguinal hernia after LRP was similar, regardless of the laparoscopic approach, and was comparable or lower than the risk noted in published open radical retropubic prostatectomy series. No specific risk factors for post-LRP inguinal hernia development were identified.

Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP) and with the extraperitoneal LRP (ELRP) during the learning curve (LC). Data of the initial 40 TLRP (Group 1) were retrospectively compared with the initial 40 ELRP (Group 2). Each Group of patients was operated by two different surgeons. The overall surgical time (175 min x 267.6 min; p < 0.001) and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001) were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5%) represented by one case of bleeding and one case of rectal injury, whereas four complications (10%) were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675). Open conversion occurred once in each Group (2.5%). Overall postoperative complications were similar (52.5% x 35%; p = 0.365). Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary), leading to one death in this group. No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.