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Extrafascial Laparoscopic Radical Prostatectomy

New Technologies
View in high definition Video requirements
Pansadoro Vito,
Vincenzo Pansadoro Foundation,
Rome

PERSONAL COMMENTS:
The other authors: Paolo Emiliozzi, Giorgio Federico, Marco Martini, Alberto Pansadoro, Maurizio Pizzo, Paolo Scarpone
Vincenzo Pansadoro Foundation, Rome, Italy

ABSTRACT:
INTRODUCTION & OBJECTIVES
Long term results of radical retropubic prostatectomy (RRP) for the treatment of locally advanced prostate cancer are well known. Surgery is considered one of the best options for T2-T3 patients. Can laparoscopic radical prostatectomy duplicate these results?

MATERIALS AND METHODS
An innovative technique of laparoscopic extrafascial radical prostatectomy is presented in this video. The prostate and the seminal vesicles can be removed completely intact and contained within the surrounding anatomical fascia. Through a trans peritoneal approach, a cleavage plane is developed between the rectal wall and the posterior layer of the Denovillier fascia. This anatomical plane is extended until the prostatic apex. The Retzius space is then entered and the cleavage plane between the prostate and the bladder is identified. Subsequently, the plane between the bladder and the anterior layer of the Denovillier fascia is developed. After the previously prepared space is reached, the vascular pedicles are severed and the prostate and seminal vesicles are removed “en block”.

RESULTS
From January 2002 to June 2006, 60 patients have undergone this technique. 31 patients had stage pT2 and 29 stage pT3, with Gleason grades between 6 to 9. All patients were node negative. Surgical margins were positive in 1/31 pT2 (3.2%) and 7/29 pT3 (24.1%). At a median follow up of 30 months (range of 6-57 months), biochemical progression occurred in 0/31 pT2 patients and 4/29 pT3 (13.7%) patients.

CONCLUSIONS
There has been stage migration in recent years due to earlier diagnosis of prostate cancer. Laparoscopic prostatectomy is a relatively recent technique when compared to open prostatectomy. Comparable numbers and long term follow up are still unavailable. The percentage of positive surgical margins and the biochemical disease free progression rates appear to be equivalent, but follow up is still short. Longer follow up is needed to confirm these extremely promising results.
laparoscopic left hepatectomy with direct glissonian approach
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