ENDOUROLOGY & LAPAROSCOPY

Laparoscopic Extraperitoneal Radical Prostatectomy in Complex Surgical Cases
Rodriguez AR, Kapoor R, Pow-Sang JM
Department of Interdisciplinary Oncology, Division of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida
J Urol. 2007 May;177(5):1765-70

• Purpose: Patients with a high body mass index, previous pelvic surgery or large prostate size are not considered ideal candidates for radical prostatectomy. We assessed the impact of body mass index, previous pelvic surgery and prostate weight on perioperative and pathological outcomes in patients treated exclusively with laparoscopic extraperitoneal radical prostatectomy.
• Materials and Methods: From January 2004 to May 2005, 300 patients underwent laparoscopic extraperitoneal radical prostatectomy. Patients were divided into groups, including body mass index groups 1 (25 kg/m(2) or less), 2 (25.1 to 30), 3 (30.1 to 36) and 4 (greater than 36); prostate weight groups 1 (20 gm or less), 2 (20.1 to 40), 3 (40.1 to 60) and 4 (more than 60); and prior surgery groups 1 (no previous pelvic or prostatic surgery) and 2 (previous pelvic or prostatic surgery).
• Results: Logistic regression demonstrated that body mass index, large prostate size and previous pelvic surgery did not affect margin status. The Kruskal-Wallis test was performed to analyze if body mass index, large prostate size and previous pelvic surgery had an effect on perioperative variables. Only prostate weight correlated with a delay in Foley catheter removal (3 days, p = 0.0005). The Wilcoxon rank sum test showed that patients with a higher body mass index had a slightly prolonged hospital stay (16 hours, p = 0.02). Patients with a prostate of more than 40 gm had slightly increased blood loss (56 cc, p = 0.03), which did not affect the transfusion rate.
• Conclusions: Laparoscopic extraperitoneal radical prostatectomy can be performed in complex surgical cases without increased perioperative morbidity. Obese patients and those with a large prostate who prefer surgery as a treatment option for localized prostate cancer may benefit from the advantages that laparoscopic extraperitoneal radical prostatectomy offers.
  
  
• Editorial Comment
  The new era of minimally invasive surgery demonstrates the feasibility of laparoscopic retropubic radical prostatectomy in patients with high body mass index, previous pelvic surgery or large prostate size. In general surgery laparoscopic procedures are highly encouraged for patients that are more complex due to better outcomes compared to open surgery. In urology, we are still taken “baby steps” demonstrating slowly the advances in minimally invasive surgery. The authors should be congratulated for the elegant manuscript demonstrating the feasibility and good outcome of laparoscopic surgery in complex surgical patients.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA