Extraperitoneal standard laparoscopic radical prostatectomy

PURPOSE: To describe our preliminary experience with the extraperitoneal approach for laparoscopic radical prostatectomy. PATIENTS AND METHODS: Between February and December 2002, we performed 100 laparoscopic radical prostatectomies by an extraperitoneal approach. RESULTS: Of the procedures, 98 were completed as planned, while conversion to a transperitoneal approach was necessary in 2 patients with previous mesh hernia repair. The mean operative time was 163 minutes. The mean operative blood loss was 375 mL. The transfusion rate was 3%. No rectal, bowel, ureteral, or nervous injury was observed. There were no major complications. There were nine minor complications (four anastomotic leakages, one rectus muscle hematoma, four cases of acute urinary retention). The mean hospital stay was 6.1 days. Mean catheterization lasted 6 days. The pathologic stage was T2a, T2b, T2c, T3a, and T3b in 17%, 22%, 39%, 12%, and 10%, respectively. The mean Gleason score was 7. The margins were positive in 15% of the pT2 and in 35% of the pT3 tumors; 48% of the positive margins occurred in the first 25 cases. The median follow-up was 12 months; 93% of the patients had a serum prostate specific antigen concentration <0.2 ng/mL. No patient has presented with clinical port-site metastasis. All the patients were evaluated by questionnaire sent by mail before and after the surgery. With a median follow-up of 12 months, 86% of the patients were continent (no pads), 7% of the patients used 1 precaution pad, and 7% had need for 1 pad routinely. With a median follow-up of 6 months, among the preoperatively potent patients (IIEF5 >20), the postoperative erection and intercourse rate was 64% and 43% in patients with bilateral and unilateral nerve-bundle preservation, respectively. CONCLUSION: The extraperitoneal technique is a reliable approach for laparoscopic radical prostatectomy. The choice between a transperitoneal or an extraperitoneal approach depends on the surgeon's experience.