Adult urologyComplete solo laparoscopic radical prostatectomy: initial experience
Section snippets
Material and methods
Between March 2001 and February 2002, 16 consecutive patients, with clinically localized prostate cancer underwent CS LRP. We compared them with the last 16 patients treated with standard LRP between April and December 2000. All patients were operated on by the same surgeon (P.A.) in a private hospital. The preoperative characteristics of the two groups are presented in Table I.
Our technique of standard LRP, using five trocars and requiring 2 human assistants, has been previously described.9
Results
All procedures were completed successfully. However, for 3 patients (18.75%) of each group, conversion to an additional human assistant was required for 1 hour. The additional human assistant was required during particularly difficult dissection of the posterior bladder neck, usually encountered in obese patients or patients with a large prostate or a large median lobe.
The average operative time was 324 ± 48.9 minutes (range 240 to 390) in the CS group and 347 ± 53.7 minutes (range 210 to 420)
Comment
LRP has been described as a spectacular operation, requiring considerable surgical experience and having a lengthy learning curve.10 Thus, it may look excessive trying to perform it in a CS manner.
However, the robots manipulating the laparoscope are already routinely used in many institutions in thoracic,11 gynecelogic,12 and, particularly, urologic surgery. Partin et al.5 reported a feasibility study using one or two robotic arms in 17 cases. Among the procedures completed, there was a very
Conclusions
CS LRP is feasible by a urologist well trained in laparoscopy. The operative time, conversion and complication rates, short-term cancer control, and functional results compare favorably with standard LRP. Furthermore, one can benefit from the specific advantages of the CS method in terms of direct control of the operative view, standardization of the operative assistance, greater stability of the laparoscope, and many secondary advantages that greatly enhance the surgeon’s comfort. Moreover,
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