Comparison of lymph node yield in robot‐assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

? To investigate both the feasibility and the adequacy of pelvic lymph node dissection (PLND) during robot‐assisted laparoscopic prostatectomy (RALP) by comparing lymph node yields obtained during RALP with those obtained during traditional open retropubic radical prostatectomy (RRP).

PATIENTS AND METHODS

? We retrospectively reviewed 1047 patients who underwent radical prostatectomy between 2001 and 2009. ? In all, 626 patients underwent RALP while 421 patients had traditional open RRP. All patients undergoing bilateral PLND were included in our analysis. ? Lymph node yields and lymph node involvement for each surgical approach were calculated and examined. ? PLND‐related complications were analysed.

RESULTS

? Of the 1047 patients, 816 patients underwent bilateral PLND of whom 473 underwent RALP, while 343 underwent RRP. The mean lymph node yields for the RALP cohort (7.1, interquartile range 4–10) was significantly higher (P < 0.001) than for the RRP cohort (6.0, interquartile range 3–8). ? The percentage of patients with nodal involvement was 1.1 for RALP and 2.3 for RRP (P= 0.167). ? Mean age, preoperative PSA values, and pre‐ and postoperative Gleason scores were similar between the two cohorts. ? PLND‐related complications were similar between both cohorts.

CONCLUSIONS

? In patients undergoing RALP, PLND is feasible and provides lymph node yields comparable with those of the standard open approach. ? PLND should be strongly considered in all radical prostatectomy patients when clinically indicated, regardless of surgical technique.     

Feasibility of a novel extraperitoneal two‐port laparoendoscopic approach for radical prostatectomy: An initial study

The aim of this study was to describe the surgical technique and to report the early outcomes of an original extraperitoneal two‐port laparoendoscopic approach for radical prostatectomy. A total of 22 consecutive patients diagnosed with early‐stage prostate cancer (cT1c, cT2N0) were operated on and included in this analysis. A multichannel port with three 5‐mm trocars, providing easier instrument handling, was inserted extraperitoneally through a 2.5‐cm lower umbilical “U” incision. An additional 12‐mm port was inserted into the left fossa to allow an adequate working angle to facilitate the most critical steps of the surgical procedures. The operation was successfully completed in all patients; one patient required an additional 5‐mm port to control bleeding. The median operation time was 259 min (range 207–453 min), and the fluid loss, including urine and blood, was 946 mL (range 257–1821 mL). The median Foley catheter indwelling period was 6 days (range 3–11 days) after surgery. No intraoperative complications occurred. Judging from this initial trial, this procedure can be safely carried out if the surgeon is familiar with conventional five‐port laparoscopic radical prostatectomy.     

Urinary incontinence after robot‐assisted radical prostatectomy: Pathophysiology and intraoperative techniques to improve surgical outcome

Robot‐assisted radical prostatectomy has been shown to have comparable and possibly improved postoperative continent rates compared with retropubic and laparoscopic radical prostatectomy. However, postoperative urinary incontinence has remained one of the most bothersome postoperative complications. The basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. Therefore, improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of urinary continence. It might be necessary to carry out three steps to realize improvement of the early return of urinary continence after robot‐assisted radical prostatectomy: (i) preservation (bladder neck, neurovascular bundle, puboprostatic ligament, pubovesical complex, and/or urethral length, etc.); (ii) reconstruction (posterior and/or anterior reconstruction, and/or reattachment of the arcus tendineus to the bladder neck, etc.); and (iii) reinforcement (bladder neck plication and/or sling suspension, etc.). On the basis of these steps, further modifications during robot‐assisted radical prostatectomy should be developed to improve urinary continence and quality of life after robot‐assisted radical prostatectomy.     

经尿道电切与气化切割和激光治疗前列腺增生症的疗效比较

目的 :比较经尿道电切前列腺术 (TURP) ,经尿道前列腺气化切除术 (TUVP)及经尿道接触式激光前列腺切除术 (TULP)的治疗效果。方法 :在 30 0 0例前列腺增生症患者中 ,按三种术式各随机抽取 2 0例术前条件具有可比性的患者 ,进行疗效比较。结果 :3种术式患者手术前后前列腺症状评分 (IPSS)、生活质量评分(QOL)、最大尿流率 (MFR)、剩余尿 (PVR)比较均得到显著改善 (P <0 .0 1) ,3组之间相比差异无显著性意义(P >0 .0 5 )。手术时间 :TUVP及TURP组明显短于TULP组 (P <0 .0 1) ,术中失血量及术后置管时间 :TUVP及TULP组明显少于TURP组 (P <0 .0 1)。TURP组术后继发感染、出血、暂时性尿失禁发生率少于TUVP及TULP组。结论 :3种术式治疗效果相同 ;TUVP操作简单、安全 ,对初学者来说尤其适宜 ;TURP仍为治疗BPH的金标准术式