Adam W Levinson1, Li-Ming Su. 1. James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. alevins5@jhmi.edu
Abstract
PURPOSE OF REVIEW: Laparoscopic radical prostatectomy is now considered the standard of care at many centers for the treatment of localized prostate cancer. As with other surgical approaches, there has been an evolution in surgical techniques. Critical evaluation of the effects of these changes on clinical and pathologic outcomes continues. RECENT FINDINGS: The technique of nerve sparing laparoscopic radical prostatectomy should attempt to mimic the techniques and outcomes of open surgery, while maintaining the advantages of reduced blood loss and morbidity, and greater visualization. Long-term functional and oncologic outcomes appear equivalent to open surgery. Surgical approaches based upon recent anatomic studies of the periprostatic neuroanatomy continue to spur both advances and debate. Athermal dissection near the neurovascular bundle, along with high release of the surrounding fascia, may hasten recovery of erectile function. Techniques of sparing or reconstructing the puboprostatic ligaments and support of the bladder are evolving in efforts to improve continence results. Debate over the merits of transperitoneal vs. extraperitoneal approaches to laparoscopic prostatectomy continues. SUMMARY: Nerve sparing laparoscopic radical prostatectomy, although technically challenging, has proven to be an excellent alternative for dedicated centers wishing to provide a minimally invasive surgical option to their patients with localized prostate cancer.
PURPOSE OF REVIEW: Laparoscopic radical prostatectomy is now considered the standard of care at many centers for the treatment of localized prostate cancer. As with other surgical approaches, there has been an evolution in surgical techniques. Critical evaluation of the effects of these changes on clinical and pathologic outcomes continues. RECENT FINDINGS: The technique of nerve sparing laparoscopic radical prostatectomy should attempt to mimic the techniques and outcomes of open surgery, while maintaining the advantages of reduced blood loss and morbidity, and greater visualization. Long-term functional and oncologic outcomes appear equivalent to open surgery. Surgical approaches based upon recent anatomic studies of the periprostatic neuroanatomy continue to spur both advances and debate. Athermal dissection near the neurovascular bundle, along with high release of the surrounding fascia, may hasten recovery of erectile function. Techniques of sparing or reconstructing the puboprostatic ligaments and support of the bladder are evolving in efforts to improve continence results. Debate over the merits of transperitoneal vs. extraperitoneal approaches to laparoscopic prostatectomy continues. SUMMARY: Nerve sparing laparoscopic radical prostatectomy, although technically challenging, has proven to be an excellent alternative for dedicated centers wishing to provide a minimally invasive surgical option to their patients with localized prostate cancer.
Authors: Xavier Cathelineau; Rafael Sanchez-Salas; Eric Barret; François Rozet; Guy Vallancien Journal: Curr Urol Rep Date: 2008-03 Impact factor: 3.092