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Evangelos N. Editorial Comment. Laparoscopic radical prostatectomy after previous transurethral resection of prostate using a catheter balloon inflated in prostatic urethra: Oncological and functional outcomes from a matched pair analysis. Comparison of efficacy and safety of conventional laparoscopic radical prostatectomy by the transperitoneal versus extraperitoneal procedure.
Daniel W. Good , Grant D. Alan McNeill. Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy: a prospective assessment of patient scar satisfaction. Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy.
Anatomy of the Pelvis. Laparoscopic Radical Prostatectomy.
Antonio L. Extraperitoneal Approach for Robotic-assisted Simple Prostatectomy. Robotic and minimal access surgery: technology and surgical outcomes of radical prostatectomy for prostate cancer. Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy. Five-year oncological outcomes of endoscopic extraperitoneal radical prostatectomy EERPE for prostate cancer: results from a medium-volume UK centre.
Dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy. Laparoscopic Radical Prostatectomy: The Results.
Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate-specific antigen: Feasibility and 1-year outcomes. Tissue engineering for the oncologic urinary bladder. Oncological and functional results of extraperitoneal laparoscopic radical prostatectomy.
Sign in. Impact of Partin nomogram on presurgical planning: intrafascial versus interfascial nerve sparing during robot-assisted radical prostatectomy. Several surgeons performed the operations. EERPE can be learned after thorough technical training under expert monitoring within a short teaching phase. Pelvic lymph node dissection took place in Regarding PSA follow-up, it is essential to consider, that one year is a relatively short follow-up time to evaluate the oncological aspect of radical prostatectomy, as biochemi-.
Tim J. Dudderidge , Patrick Doyle , Erik K. Radikale Prostatektomie — pro laparoskopisch. Robot-Assisted Radical Prostatectomy. Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of patients. John W. Bilateral vs unilateral laparoscopic intrafascial nerve-sparing radical prostatectomy: evaluation of surgical and functional outcomes in patients. Impact of Partin nomogram on presurgical planning: intrafascial versus interfascial nerve sparing during robot-assisted radical prostatectomy.
Minh Do , Evangelos N. Liatsikos , Panagiotis Kallidonis , Andrew W. Wedderburn , Anja Dietel , Kevin J. Turner , and Jens-Uwe Stolzenburg. Functional and oncological outcomes of men under 60 years of age having endoscopic surgery for prostate cancer are optimal following intrafascial endoscopic extraperitoneal radical prostatectomy.
Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy? Controversial Case in Endourology. Brian R. Matlaga and Evangelos N. Liatsikos, Section Co-Editors. Extraperitoneal Laparoscopic Radical Prostatectomy. Harnblase und Prostata. Urinary Bladder and Prostate. The perineural invasion could be observed in The positive surgical margin variable PSM was In terms of disease staging, Table-6 shows that there was significant change in the Gleason score in the pre and postoperative period.
There was an increase of Table-7 shows the incidence of PSM regarding the pathological stage. We observed that 8. Furthermore, in Group 2 there was a statistical trend of positive margin with pT3 stage Table In all three technical procedures open, laparoscopic or robotic , there is a specific goal which is the healing treatment of localized prostate cancer Some authors argue that in the TLRP the initial dissection of the seminal vesicles and vas deferens facilitates the dissection step and the preservation of the neurovascular bundle.
On top of that it is easier as it promotes more physical space and light, and it also allows greater visibility of the anatomical structures leading to less tension in the anastomosis On the other hand, the ELRP brings a similar procedure to the conventional retropubic one, while maintaining the integrity of the peritoneum, allowing for less possibility of intra-abdominal complications 2.
Therefore, this access is defined as the safest one as it does not violate the peritoneal cavity 14 - This technique provides very limited space for the robotic movements, and difficult to make lymphadenectomy. It is recommended to be just started by surgeons with extensive experience in transperitoneal robotic assisted laparoscopic radical prostatectomy RALRP-TP According to Mitre et al, high costs, lack of accessibility to training and reduced budgets are the biggest problems for the spread of robot technology in low-volume centers, especially in developing countries The best parameter to evaluate the oncologic efficacy is disease-free survival, but with the impossibility to assess this parameter due to short segments, the recurrent biochemical rate is the most appropriate way, and is directly associated with the PSM rate It was suggested that these results are due to the training in laparoscopy As oppose to the above study, our series with only cases had the overall rate of PSM of Thus, the continuous learning in the extraperitoneal technique did not influence the oncological results obtained from surgical specimens.
We also observed that most cases of PSM occurred in the pathological stage pT3 If we just analyze the cases of pT2 stage, we can see a very low PSM rate 8.
In general, it is observed that during the LC, the perioperative results are lower than the ones observed with large laparoscopic or RRP series. Such results begin to improve after the learning period, which happens around cases 20 , However, the sufficient number of surgeries to bridge this period may be higher when the oncological and functional results are also evaluated. In the present study, the initial 40 cases performed by transperitoneal access, were excluded to obtain two comparable and homogeneous groups, in which all the surgeries were performed by the same surgical technique, via the extraperitoneal access and by the same surgeon.
At the same time, Kown et al 23 demonstrated that the LC in robotics is extremely short, with only 25 procedures. On the other hand, Peters et al 24 reported that the PSM rate improved significantly after performing robotic surgeries. Despite the quality of the meta-analysis described above, Picozzi et al 26 found selectivity and the heading of some cases for treatment with robotic technology. In our series, when we analyze the surgical performance data from both groups, we can verify that the average time to perform anastomosis, the time for the urinary catheter removal and estimated blood loss were much lower in Group 2 than in Group 1.
These data suggest that there was a technical improvement during the course of time, reflecting the learning process of the extraperitoneal technique. Even so, we found that the estimated bleeding rates for both groups were at the lower limit of the rates found in the literature, ranging from In our series there was no conversion to open surgery due to bleeding. All conversions occurred due to technical difficulties, mainly because of obesity and retropubic adhesions, the latter being probably caused by the inflammatory process associated with the prostate biopsy.
The creation of the physical space in the extraperitoneal access can be obtained to some technical difficulties in some cases. In this series specifically, there was one case in one patient during the creation of the retroperitoneal space, a tiny perforation in the peritoneal envelope. Therefore, the conversion to TLRP was necessary. There were no cases of hypercarbia because the operative time was not too long average of Therefore, the learning curve is more difficult than in the TRLP technique, but gradually overcome with the previous experience in laparoscopy.
I believe that ELRP could be taught at residency or special programs for the urological community in Brazil. Due to the retrospective nature of this study, it was not possible to properly assess functional aspects such as sexual potency and urinary incontinence. In our study, there were rectal lesions in two cases, which were promptly corrected intraoperatively. Although the anastomosis was done with continuous suture, in two cases there were prolonged urinary extravasation through the drain.
These complications were treated only with prolonged bladder catheterization average length of 14 days. In only one case, after the removal of the urinary catheter, the patient had urinary retention due to the localized edema in anastomosis. Late complications presented in our study may be inherent to any surgical technique, by either the open or laparoscopic technique. It was observed during learning curve a significant reduction in the average time to perform the urethral-bladder anastomosis, the estimated blood loss and the removal time of the urinary catheter, seen in Group 2, that suggest that there was an improvement of the surgical technique with time.
There was no difference in early oncological results during the technical evolution, when analyzing the ELRP technique. Laparoscopic radical prostatectomy: initial short-term experience. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Int Braz J Urol. Laparoscopic radical prostatectomy by extraperitoneal access with duplication of the open technique.
J Urol. Laparoscopic radical prostatectomy: 10 years experience. Overheads on the personal evolution technique in 5-years experience]. Actas Urol Esp. Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Classification of surgical complications: a new proposal with evaluation in a cohort of patients and results of a survey.
Ann Surg. Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost. Curr Urol Rep.
Preliminary evaluation after 28 interventions]. Presse Med.
Atug F, Thomas R. Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: which one?