[Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions].

OBJECTIVE: Evaluate the technical feasibility of laparoscopic radical prostatectomy, its carcinological efficacy and per- and post-operative morbidity. PATIENTS AND METHODS: We performed radical prostatectomy using a new laparoscopic technique in 28 patients between February 1 and August 31, 1998.
RESULTS: Radical prostatectomy was achieved totally by a laparoscopic approach in 24 patients (86%). No conversion was required in the last 14 patients. In 9 patients (32%) ilio-obturator node resection was also performed as indicated by preoperative extension work-up. Mean operative time was 270 minutes. The only major complication was one rectal wound (patient n degree 8) which had a benign course after suturing under laparoscopy. The bladder catheter was removed a mean 7.7 days after the procedure. Five patients (18%) required transfusions (mean 2.7 units, range 2-3). Rapid discharge on day 3 was possible due to rapid pain relief postoperatively. Tumor classes were pT2 in 26 patients, NO in 9, NX in 17. The surgical border was doubtful at the apex in one case. The last prostate specific antigen assay was below detectable levels (< 0.1 ng/ml) in 16 patients (89%) among the 18 with levels know prior to the procedure. Continence was assessable in 20 patients after a 1 to 6 month follow-up. Continence was perfect in 18 patients and becoming so in 12. Sexual activity was not assessed in this series due to the short follow-up.
CONCLUSION: Radical prostatectomy can be reasonably performed as a routine laparoscopic procedure by a well-trained team. The cancerological results in this series were equivalent to those with conventional retropubic surgery and morbidity was very low. Improved operative vision was considerable, allowing much more precise dissection. The laparoscopic technique appears to be an important improvement for radical prostatectomy and should help improve functional outcome.