Complete solo laparoscopic radical prostatectomy: initial experience

doi:10.1016/S0090-4295(03)00027-X

Urology

Volume 61, Issue 4, April 2003, Pages 724-728

https://doi.org/10.1016/S0090-4295(03)00027-X Get rights and content

Abstract

Objectives

To demonstrate the feasibility of “complete solo” (CS) laparoscopic radical prostatectomy (LRP) performed solely with robotic manipulation of the laparoscope and without any human assistant at all. A comparison was made between CS LRP and the standard technique to identify the advantages and drawbacks.

Methods

Sixteen consecutive patients undergoing CS LRP were compared with the last 16 patients undergoing standard LRP. The standard procedure was performed with five trocars and one human assistant. Therefore, the surgeon had three instruments immediately available and could switch quickly from one to another, while the assistant held the laparoscope and a retractor. The CS method used a voice-controlled robotic arm to manipulate the laparoscope and a mechanical arm for the assisting instrument.

Results

The mean operative time in the CS and standard groups was 324 and 347 minutes, respectively (P >0.5). An additional human assistant was required, for 1 hour, in 3 patients of each group. No significant difference was noted between the two groups in terms of catheterization time, hospital stay, positive margin rate, complications, short-term cancer control, or functional results. The CS method has been demonstrated to be highly cost-effective compared with the standard technique.

Conclusions

The CS LRP is feasible and compares favorably with the standard technique. It offers unique advantages in terms of direct control of the operative view, standardization of the assistance, and higher stability of the laparoscope, thus greatly enhancing the surgeon’s comfort. The diminished need for human operative assistance provides significant economic and organizational benefits.

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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Comparer trois voies d’abord de prostatectomie totale (voie ouverte rétropubienne, voie laparoscopique transpéritonéale conventionnelle et laparoscopique robot-assistée), en terme de résultats techniques, carcinologiques et fonctionnels sur la continence.
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Les trois groupes se sont avérés être comparables, seul l’âge moyen était statistiquement plus bas dans le groupe voie ouverte (p = 0,018). Au plan technique, durée de sondage (p < 2,2 × 10⁻¹⁶), pertes sanguines (p < 3,12 × 10⁻⁵) et temps opératoires (p < 2 × 10⁻⁴) étaient significativement en faveur des voies laparoscopiques, plus clairement dans sa forme conventionnelle que robot-assistée. La différence mise en évidence concernant le taux de marges positives n’est pas statistiquement significative (p = 0,37). Enfin, le taux de continence était sensiblement supérieur dans les groupes laparoscopiques, sans significativité statistique (76 % pour le groupe voie ouverte versus 96,8 et 85,3 % pour les groupes laparoscopie et robot-assisté).
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La prostatectomía radical (PR) en cualquiera de sus cuatro abordajes (perineal (PRP), retropúbico (PRA), laparoscópico (PRL) o robótico (PRR)) es hoy en día, el estándar de tratamiento quirúrgico del cáncer de próstata en estadios localizados. Parece claro, que los abordajes mínimamente invasivos (laparoscopia y robótica) son capaces de disminuir la estancia hospitalaria así como la pérdidas sanguíneas y por tanto la necesidad de transfusión. Asimismo, los resultados a medio plazo de la laparoscopia y a corto plazo de la robótica, parecen indicar, que son igual de seguras oncológicamente y capaces de conseguir los mismos o incluso superiores, resultados funcionales.
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Adult urologyComplete solo laparoscopic radical prostatectomy: initial experience

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Comment

Conclusions

J Urol

J Urol

J Urol

Urol Clin North Am

Urology

Lancet

J Urol

Laparoscopic radical prostatectomypreliminary results

Urology

Adult urology
Complete solo laparoscopic radical prostatectomy: initial experience