NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Results of Minimally Invasive Laparoscopic Radical Prostatectomy in Men with Localized Prostate Cancer: Single Surgeon Experience.
Ketul K. Shah, MD,Mch, Douglas M. Dahl, MD.
Massachusetts General Hospital, Boston, MA

Background: To perform a retrospective review of all laparoscopic radical prostatectomy (LRP) cases performed at our institution, to assess the operative parameters and morbidity associated with the procedure.
Methods: In a retrospective review, clinical, operative and post operative data of patients undergoing LRP by a single surgeon was collected from the clinical charts and operative notes. All statistical analyses were performed with the SAS System.
Results: A total of 534 patients with localized prostate cancer underwent LRP between October 2001 and December 2005. The initial cases were performed transperitoneally (24.9%) and extra peritoneal approach (75.1%) was adopted from February 2003. The mean age was 58.3 years and 152 (28.5%) patients had BMI of more than 30. The mean preoperative PSA and Gleason sum were 5.85 ng/dl and 6.21 respectively. Lymph node dissection was performed in 36% cases and both nerves were spared in 92.7% patients. 53 patients with concurrent inguinal hernia were treated by laparoscopic meshplasty. The mean operative time and blood loss were 162 minutes and 481.5 ml respectively. 9 patients (1.6%) needed blood transfusion. The average hospital stay was 1.6 days.
13 patients (2.4%) had postoperative urinary leak and 5(0.93%) patients developed ileus. 2 patients had disruption of urethro-vesical anastomosis and needed exploration and resuturing. 7 patients (1.4%) had pelvic hematoma out of which 1 patient needed exploration and 2 patients were treated by percutaneous drainage. 3 patients with symptomatic lymphocele were treated by transperitoneal laparoscopic marsupilisation. 4 patients (0.74%) developed DVT in the lower limbs.
98 patients (18.35%) had margins positive. The follow up range from 4 to 60 months (Mean=14.1 months). At the end of minimal 12 months follow up, 88.7% patients were fully continent. 8.8% had mild incontinence, 2% had moderate incontinence and 1 patients (0.34%) had severe incontinence. 170 (34%) patients achieved spontaneous erections without any treatment and 196 (39.2%) had erections with the help of oral medications. During the course of follow-up, 17 patients (3.46%) had rise in PSA, out of which 12 patients received salvage RT, 2 received hormone therapy and 3 patients are being followed up without adjuvant treatment.
Conclusion: LRP is feasible in patients with localized prostate cancer and can offer potential advantages of reduced blood loss, preservation of erectile function, recovery of urinary control, shorter hospital stay and faster convalescence. The overall complication rate is compatible with other early series of laparoscopic radical prostatectomy.

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