Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations.

BACKGROUND: Our purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy.

METHODS: We describe an original technique of laparoscopic radical prostatectomy performed in 65 successive patients during 11 months.

RESULTS: Radical prostatectomy was performed entirely by laparoscopy in 59 patients (91%). The median operating time was 265 min, including times for lymphadenectomy performed in 33% of patients. Preoperative complications included one rectal injury, sutured laparoscopically with an uneventful postoperative course, and one epigastric artery injury which needed secondary open procedure. The transfusion rate was 15.4% (10 patients). Median postoperative vesical catheterization lasted 7 days. The reduction of postoperative pain allowed rapid discharge of patients, by the fourth postoperative day in 60% of consenting patients. As regards oncological results, resection margins were negative in 57 patients (87.7%). The last prostate-specific antigen (PSA) assay was undetectable (<0.1 ng/ml) in 85.7% of the 42 patients in whom PSA was available more than 1 month after the operation.

CONCLUSIONS: Radical prostatectomy can be routinely performed by laparoscopy by an experienced team. Short-term oncological data were identical to the results of conventional retropubic surgery, and morbidity was low. The laparoscopic approach could constitute in the future a technical improvement over radical prostatectomy if long-term oncological results are confirmed and if improvement of intraoperative vision improves the functional results of this operation.