ENDOUROLOGY & LAPAROSCOPY

Laparoscopic radical prostatectomy
Trabulsi EJ, Guillonneau B
Section of Minimally Invasive Surgery, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
J Urol. 2005; 173: 1072-9

• Purpose: After the pioneering period when only few teams were performing the procedure, the laparoscopic approach to radical prostatectomy has become widespread with several technical variations. A comprehensive review of the published literature on laparoscopic radical prostatectomy was performed to determine the current state of the art of this surgical innovation in terms of perioperative parameters, functional results and cancer control.
• Materials and Methods: English language, peer-reviewed articles published before June 2004 concerning laparoscopic radical prostatectomy were found by MEDLINE query. All articles were analyzed and none was a priori excluded. Conclusions were drawn from series of 50 or more patients.
• Results: Laparoscopic radical prostatectomy is being performed at multiple centers worldwide using various surgical approaches and technologies. Analysis of perioperative parameters, including surgical blood loss, operative time, complications and convalescence, demonstrated low morbidity and showed a clear trend toward improvement with increased experience. The reported positive surgical margin rates were lower in series that are more recent. As measured by prostate specific antigen recurrence and disease-free intervals, oncological results and cancer control rates are difficult to ascertain in the immature series published to date. Functional results in terms of postoperative urinary and sexual function appear encouraging.
• Conclusions: Overall, the current operative, oncological and functional results of laparoscopic radical prostatectomy appear to approximate those of open radical retropubic prostatectomy. These results justify the considerable interest of the urological community in laparoscopy, as evidenced by its widespread application. Nevertheless, longer follow-up and more mature data are needed definitively to establish laparoscopic radical prostatectomy as an alternative to the retropubic approach.
  
  
• Editorial Comment
  It is clear that laparoscopic radical prostatectomy is a surgical technique that can be learned and reproduced anywhere in the globe. Long-term data is still lacking in terms of oncological safety but overall this is a technique that seems comparable to open retropubic prostatectomy.

Dr. Fernando J. Kim
Assistant Professor of Urology
University of Colorado Health Sciences Center
Denver, Colorado, USA