Laparoscopic radical prostatectomy: Initial short-term experience

Objectives. To determine the feasibility and efficacy of a laparoscopic approach to the radical retropubic prostatectomy (RRP). Methods. A transperitoneal laparoscopic technique was developed to perform an RRP. Intra-abdominal access was obtained through five 10-mm trocars. After dissection of the prostate, the urethrovesical anastomosis was created via a transvesical approach, The prostate was removed by extending the umbilical incision. Results, Between September 1991 and May 1995, nine laparoscopic RRPs were performed, The operative time averaged 9.4 hours. Only 1 of 9 patients had a positive surgical margin that involved the urethra. Six of 9 patients were completely continent postoperatively. Of the 4 patients who were potent preoperatively, 2 continued to have erections, There were three complications: cholecystitis, thrombophlebitis associated with a pulmonary embolism, and a small bowel hernia into a trocar site, Conclusions, Laparoscopic radical prostatectomy is feasible but currently offers no advantage over open surgery with regard to tumor removal, continence, potency, length of stay, convalescence, and cosmetic result. (C) 1997, Elsevier Science Inc. All rights reserved.