Abstract

PENA GONZALEZ, J.A. et al. Extraperitoneal laparoscopic radical prostatectomy: First 50 cases in a middle size hospitaL. Evaluation of the learning curve. Actas Urol Esp [online]. 2007, vol.31, n.7, pp.732-737. ISSN 0210-4806.

Objective: Report our experience in the first 50 cases of laparoscopic radical prostatectomy performed in our Hospital. We describe the surgical technique and the modifications that we have applied. Time consumptions and technical difficulties are reviewed. Methods: From January 2005 to September 2006 we indicated 52 extraperitoneal laparoscopic radical prostatectomies. Two of them were done with the advice of a master and won’t be included in our series. We followed the Brussels technique with some modifications. Results: We completed integrally by laparoscopy the 78% of the cases (39/50). The 11 converted cases were done within the 25 first ones. Mean operating time for the pure laparoscopic cases was 280 minutes. We divide surgery in six steps with the following mean times in minutes: Trocars placement (30), seminal vessels dissection (95), Santorini (25), specimen in endobag (55), anasthomosis (55) and final (15). After case 25, the results improve. The most challenging step was seminal vessels dissection. Transfusion rate has been 7%. The mean hospitalization time has been 4 days with a 30% of patients discharged 48 hours after surgery. Positive surgical margins were observed in 12%. Two of our patients presented major complications (4%). Conclusions: Extraperitoneal laparoscopic radical prostatectomy is feasible in an institution like ours if it has the aim of invest a big effort, especially regarding operating time. The most demanding steps are the dissection of the vesicoprostatic plane and the anasthomosis. There is a clear progression after case 25.

Keywords : Prostate Cancer; Radical prostatectomy; Laparoscopy.

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