Arroyo C

Language: Spanish
References: 16
Page: 102-107
PDF size: 532.01 Kb.

ABSTRACT

Introduction. Laparoscopic radical prostatectomy is done routinely all over the world, no matter its steep learning curve. When the extraperitoneal approach is used, the inguinal channel is dissected; if we complete this with the reduction of an inguinal hernia, most of the laparoscopic hernioplasty is already done, making it easy to perform both procedures in the same surgery without increasing significantly the surgical time or its complications.
Methods. We present a detailed description of the procedure and a video that is available by email in which both procedures are done. We have divided them in 13 critical steps. The patient is placed in a moderate Trendelemburg position and five trocars are placed. The radical prostatectomy involves: 1. dissection of the Retzius space; 2. bilateral limphadenectomy; 3. endopelvic fascia opening; 4. resection of the bladder neck; 5. dissection of the seminal vesicles and vas deferens; 6. opening of the Denonvilliers fascia; 7. control of the prostatic pedicles and nerve preservation; 8. suture of the Santorini complex; 9. section of the distal urethra; 10. uretro-vesical anastomosis; 11. placement of the foley catheter and aspirative drainage; 12. placement of the prosthetic mesh; and 13. extraction of the surgical specimen and drainage placement. Ending the procedure with hemostasis and verifying the impermeability of the vesico-urethral anastomosis.
Results. This procedure was done with no surgical complications and the total bleeding was of 300cc with total surgical time of 240 minutes. During the immediate postoperatory period larger serohematic drainage was observed that could be due to the mesh placement. The patient was discharged 72 hours later with a surgical report of an organ confined with negative surgical margins prostate cancer with negative limphadenectomy. He is currently in his postoperatory follow-up.
Conclusions. Laparoscopic radical prostatectomy can be done with other procedures such as laparoscopic hernia repair with the same extraperitoneal approach. It is important to emphasize that the prostatectomy has to be performed without any complications in order to avoid the risk of infection of the prosthetic mesh.

REFERENCES

1. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997;50(6):854-7.

2. Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G. Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions. Presse Med. 1998;27(31):1570-4.

3. Bollens R, Vanden Bossche M, Roumeguere T, Damoun A, Ekane S, Hoffmann P. Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol. 2001;40(1):65-9.

4. Raboy A, Albert P, Ferzli G. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Surg Endosc. 1998;10(10):1264-7.

5. Tewari A, Srivasatava A, Menon M. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 2003;92(3);205-10.

6. Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou C. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology. 2003;62(2):292-7.

7. Teber D, Erdogru T, Zukosky D, Frede T, Rassweiler J. Prosthetic mesh hernioplasty during laparoscopic radical prostatectomy. Urology. 2005;65(6):1173-8.

8. Allaf ME, Hsu TH, Sullivan W, Su LM. Simultaneous laparoscopic prosthetic mesh inguinal herniorrhaphy during transperitoneal laparoscopic radical prostatectomy. Urology. 2003;62(6):1121.

9. Ghavamian R, Knoll A, Teixeira JA. Simultaneous extraperitoneal laparoscopic radical prostatectomy and intraperitoneal inguinal hernia repair with mesh. JSLS. 2005;9(2):231-4.

10. Stolzenburg JU, Rabenalt R, Dietel A, Do M, Pfeiffer H, Schwalbe S, Dorschner W. Hernia repair during endoscopic (laparoscopic) radical prostatectomy. J Laparoendosc Adv Surg Tech A. 2003;13(1):27-31.

11. Seifman BD, Dunn RL, Wolf JS. Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications. J Urol. 2003;169(1):36-40.

12. Parsons JK, Jarrett TJ, Chow GK, Kavoussi LR. The effect of previous abdominal surgery on urological laparoscopy. J Urol. 2002;168(6);2387-90.

13. Cathelineau X, Cahill D, Widmer H, Rozet F, Baumert H, Vallancien G. Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge. J Urol. 2004; 171(2):714-6.

14. Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol. 2002;167(1):51-6.

15. Stolzenburg JU, Truss MC, Bekos A, Do M, Rabenalt R, Stief CG. Does the extraperitoneal laparoscopic approach improve the outcome of radical prostatectomy? Curr Urol Rep. 2004;5(2):115-22.

16. Hoznek A, Antiphon P, Borkowski T, Gettman M, Katz R, Salomon L. Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology. 2003;61(3):617-22.