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Extraperitoneal Laparoscopic Radical Prostatectomy

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Retroperitoneal Robotic and Laparoscopic Surgery

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Abstract

Several trends emerged in recent years to create the possibility of performing complex minimally invasive surgery for prostate cancer. Radical prostatectomy is an operation in which surgical control of cancer and preservation of vulnerable bodily functions require great precision and experience. Only through the development of advanced videoscopic equipment, refined surgical tools, and pioneering surgical techniques has it been possible to achieve excellent outcomes for prostate cancer patients with minimally invasive surgery. In this chapter, the state of the art of laparoscopic radical prostatectomy (LRP) via an extraperitoneal approach will be reviewed. This chapter will detail the considerations for patient selection and preoperative preparation, choice of instruments, surgical technique, and postoperative management for extraperitoneal laparoscopic radical prostatectomy (eLRP). Complications and pitfalls of the techniques will be highlighted based on personal experience with this operation in over 1,300 patients and from the published literature.

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References

  1. Lau WY, Leow CK, Li AK. History of endoscopic and laparoscopic surgery. World J Surg. 1997;21(4):444-453.

    Article  CAS  PubMed  Google Scholar 

  2. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997;50(6):854-857.

    Article  CAS  PubMed  Google Scholar 

  3. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the montsouris technique. J Urol. 2000;163(6):1643-1649.

    Article  CAS  PubMed  Google Scholar 

  4. Dahl DM, L’esperance JO, Trainer AF, et al. Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center. Urology. 2002;60(5):859-863.

    Article  PubMed  Google Scholar 

  5. Guillonneau B, Abbou CC, Doublet JD, et al. Proposal for a “European scoring system for laparoscopic operations in urology”. Eur Urol. 2001;40(1):2-6. discussion 7.

    Article  CAS  PubMed  Google Scholar 

  6. Dahl DM, Barry MJ, McGovern FJ, Chang Y, Walker-Corkery E, McDougal WS. A prospective study of symptom distress and return to baseline function after open versus laparoscopic radical prostatectomy. J Urol. 2009;182(3):956-965.

    Article  PubMed  Google Scholar 

  7. Dahl DM, He W, Lazarus R, McDougal WS, Wu CL. Pathologic outcome of laparoscopic and open radical prostatectomy. Urology. 2006;68(6):1253-1256.

    Article  PubMed  Google Scholar 

  8. Brown JA, Rodin DM, Lee B, Dahl DM. Laparoscopic radical prostatectomy and body mass index: an assessment of 151 sequential cases. J Urol. 2005;173(2):442-445.

    Article  PubMed  Google Scholar 

  9. Rodriguez AR, Kapoor R, Pow-Sang JM. Laparoscopic extraperitoneal radical prostatectomy in complex surgical cases. J Urol. 2007;177(5):1765-1770.

    Article  PubMed  Google Scholar 

  10. Fahy BG, Barnas GM, Flowers JL, Nagle SE, Njoku MJ. The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery. Anesth Analg. 1995;81(4):744-750.

    CAS  PubMed  Google Scholar 

  11. Fahy BG, Barnas GM, Nagle SE, Flowers JL, Njoku MJ, Agarwal M. Effects of Trendelenburg and reverse Trendelenburg postures on lung and chest wall mechanics. J Clin Anesth. 1996;8(3):236-244.

    Article  CAS  PubMed  Google Scholar 

  12. Rassweiler J, Hruza M, Frede T, Teber D. Laparoscopic extraperitoneal ascending nerve-sparing radical prostatectomy: an effective and safe technique for apical tumors. J Endourol. 2009;22(9):13. discussion 2021.

    Google Scholar 

  13. Stolzenburg JU, Kallidonis P, Minh D, et al. Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases. J Endourol. 2009;23(9):1467-1472.

    Article  PubMed  Google Scholar 

  14. Cook H, Afzal N, Cornaby AJ. Laparoscopic hernia repairs may make subsequent radical retropubic prostatectomy more hazardous. BJU Int. 2003;91(7):729.

    Article  CAS  PubMed  Google Scholar 

  15. Dulucq JL, Wintringer P, Mahajna A. Totally extraperitoneal (TEP) hernia repair after radical prostatectomy or previous lower abdominal surgery: is it safe? a prospective study. Surg Endosc. 2006;20(3):473-476.

    Article  PubMed  Google Scholar 

  16. Brown JA, Dahl DM. Transperitoneal laparoscopic radical prostatectomy in patients after laparoscopic prosthetic mesh inguinal herniorrhaphy. Urology. 2004;63(2):380-382.

    Article  PubMed  Google Scholar 

  17. Guillonneau B, Rozet F, Cathelineau X, et al. Perioperative complications of laparoscopic radical prostatectomy: the montsouris 3-year experience. J Urol. 2002;167(1):51-56.

    Article  PubMed  Google Scholar 

  18. Matin SF. Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy. Urology. 2006;67(5):1012-1015.

    Article  PubMed  Google Scholar 

  19. Secin FP, Karanikolas N, Kuroiwa K, Vickers A, Touijer K, Guillonneau B. Positive surgical margins and accessory pudendal artery preservation during laparoscopic radical prostatectomy. Eur Urol. 2005;48(5):786-792. discussion 793.

    Article  PubMed  Google Scholar 

  20. Rogers CG, Trock BP, Walsh PC. Preservation of accessory pudendal arteries during radical retropubic prostatectomy: surgical technique and results. Urology. 2004;64(1):148-151.

    Article  PubMed  Google Scholar 

  21. Dubbelman YD, Dohle GR, Schroder FH. Sexual function before and after radical retropubic prostatectomy: a systematic review of prognostic indicators for a successful outcome. Eur Urol. 2006;50(4):711-718. discussion 718–20.

    Article  PubMed  Google Scholar 

  22. May J, McGovern F. Hemostatic hydrodissection: a new technique to promote nerve-sparing during radical retropubic prostatectomy. Curr Urol Rep. 2005;6(1):1.

    Article  PubMed  Google Scholar 

  23. Hayashi A, Takamori S, Matsuo T, Tayama K, Mitsuoka M, Shirouzu K. Experimental and clinical evaluation of the harmonic scalpel in thoracic surgery. Kurume Med J. 1999;46(1):25-29.

    Article  CAS  PubMed  Google Scholar 

  24. Sayad P, Ferzli G. The extraperitoneal approach and its utility. Surg Endosc. 1999;13(11):1168-1169.

    Article  CAS  PubMed  Google Scholar 

  25. Raboy A, Ferzli G, Albert P. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology. 1997;50(6):849-853.

    Article  CAS  PubMed  Google Scholar 

  26. Raboy A, Albert P, Ferzli G. Early experience with extraperitoneal endoscopic radical retropubic prostatectomy. Surg Endosc. 1998;12(10):1264-1267.

    Article  CAS  PubMed  Google Scholar 

  27. Hoznek A, Antiphon P, Borkowski T, et al. Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology. 2003;61(3):617-622.

    Article  PubMed  Google Scholar 

  28. Brown JA, Rodin D, Lee B, Dahl DM. Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases. Urology. 2005;65(2):320-324.

    Article  PubMed  Google Scholar 

  29. Rassweiler J, Hruza M, Teber D, Su LM. Laparoscopic and robotic assisted radical prostatectomy – critical analysis of the results. Eur Urol. 2006;49(4):612-624.

    Article  PubMed  Google Scholar 

  30. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the heilbronn technique: an analysis of the first 180 cases. J Urol. 2001;166(6):2101-2108.

    Article  CAS  PubMed  Google Scholar 

  31. Eden CG, King D, Kooiman GG, Adams TH, Sullivan ME, Vass JA. Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: does the approach matter? J Urol. 2004;172(6 Pt 1):2218-2223.

    Article  CAS  PubMed  Google Scholar 

  32. Porpiglia F, Terrone C, Tarabuzzi R, et al. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy: experience of a single center. Urology. 2006;68(2):376-380.

    Article  PubMed  Google Scholar 

  33. Stolzenburg JU, Rabenalt R, Do M, et al. Complications of endoscopic extraperitoneal radical prostatectomy (EERPE): prevention and management. World J Urol. 2006;24(6):668-675.

    Article  PubMed  Google Scholar 

  34. Stolzenburg JU, Rabenalt R, Do M, Kallidonis P, Liatsikos EN. Endoscopic extraperitoneal radical prostatectomy: the university of leipzig experience of 2000 cases. J Endourol. 2008;22(10):2319-2325.

    Article  PubMed  Google Scholar 

  35. Rassweiler J, Schulze M, Teber D, et al. Laparoscopic radical prostatectomy with the heilbronn technique: oncological results in the first 500 patients. J Urol. 2005;173(3):761-764.

    Article  PubMed  Google Scholar 

  36. Guillonneau B, Cathelineau X, Doublet JD, Baumert H, Vallancien G. Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol. 2002;43(2):123-133.

    Article  PubMed  Google Scholar 

  37. Drouin SJ, Vaessen C, Hupertan V, et al. Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol. 2009;27(5):599-605.

    Article  PubMed  Google Scholar 

  38. Paul A, Ploussard G, Nicolaiew N, et al. Oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm follow-up of 1115 procedures. Eur Urol. 2010;50(4):267-272. 2009 Sep 17.

    Article  Google Scholar 

  39. Bhayani SB, Pavlovich CP, Hsu TS, Sullivan W, Su LM. Prospective comparison of short-term convalescence: laparoscopic radical prostatectomy versus open radical retropubic prostatectomy. Urology. 2003;61(3):612-616.

    Article  PubMed  Google Scholar 

  40. Bannenberg JJ, Rademaker BM, Froeling FM, Meijer DW. Hemodynamics during laparoscopic extra- and intraperitoneal insufflation. An experimental study. Surg Endosc. 1997;11(9):911-914.

    Article  CAS  PubMed  Google Scholar 

  41. Meininger D, Byhahn C, Wolfram M, Mierdl S, Kessler P, Westphal K. Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy. Surg Endosc. 2004;18(5):829-833.

    Article  CAS  PubMed  Google Scholar 

  42. Hu JC, Nelson RA, Wilson TG, et al. Perioperative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy. J Urol. 2006;175(2):541-546. discussion 546.

    Article  PubMed  Google Scholar 

  43. Rassweiler J, Stolzenburg J, Sulser T, et al. Laparoscopic radical prostatectomy – the experience of the german laparoscopic working group. Eur Urol. 2006;49(1):113-119.

    Article  PubMed  Google Scholar 

  44. Liatsikos E, Rabenalt R, Burchardt M, et al. Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy. World J Urol. 2008;26(6):571-580.

    Article  PubMed  Google Scholar 

  45. Katz R, Borkowski T, Hoznek A, Salomon L, de la Taille A, Abbou CC. Operative management of rectal injuries during laparoscopic radical prostatectomy. Urology. 2003;62(2):310-313.

    Article  PubMed  Google Scholar 

  46. Guillonneau B, Gupta R, El Fettouh H, Cathelineau X, Baumert H, Vallancien G. Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy. J Urol. 2003;169(5):1694-1696.

    Article  CAS  PubMed  Google Scholar 

  47. Bishoff JT, Allaf ME, Kirkels W, Moore RG, Kavoussi LR, Schroder F. Laparoscopic bowel injury: incidence and clinical presentation. J Urol. 1999;161(3):887-890.

    Article  CAS  PubMed  Google Scholar 

  48. Blumberg JM, Lesser T, Tran VQ, Aboseif SR, Bellman GC, Abbas MA. Management of rectal injuries sustained during laparoscopic radical prostatectomy. Urology. 2009;73(1):163-166.

    Article  PubMed  Google Scholar 

  49. Chandler JG, Corson SL, Way LW. Three spectra of laparoscopic entry access injuries. J Am Coll Surg. 2001;192(4):478-490. discussion 490–1.

    Article  CAS  PubMed  Google Scholar 

  50. Modi P, Goel R, Dodiya S. Laparoscopic ureteroneocystostomy for distal ureteral injuries. Urology. 2005;66(4):751-753.

    Article  PubMed  Google Scholar 

  51. Solberg A, Angelsen A, Bergan U, Haugen OA, Viset T, Klepp O. Frequency of lymphoceles after open and laparoscopic pelvic lymph node dissection in patients with prostate cancer. Scand J Urol Nephrol. 2003;37(3):218-221.

    Article  PubMed  Google Scholar 

  52. Ojeda L, Sharifi R, Lee M, Mouli K, Guinan P. Lymphocele formation after extraperitoneal pelvic lymphadenectomy: possible predisposing factors. J Urol. 1986;136(3):616-618.

    CAS  PubMed  Google Scholar 

  53. Herrell SD, Trachtenberg J, Theodorescu D. Staging pelvic lymphadenectomy for localized carcinoma of the prostate: a comparison of 3 surgical techniques. J Urol. 1997;157(4):1337-1339.

    Article  CAS  PubMed  Google Scholar 

  54. Stolzenburg JU, Wasserscheid J, Rabenalt R, et al. Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration. World J Urol. 2008;26(6):581-586.

    Article  PubMed  Google Scholar 

  55. Remzi M, Klingler HC, Tinzl MV, et al. Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy verus open retropubic radical prostatectomy. Eur Urol. 2005;48(1):83-89. discussion 89.

    Article  CAS  PubMed  Google Scholar 

  56. Teber D, Erdogru T, Cresswell J, Gozen AS, Frede T, Rassweiler JJ. Analysis of three different vesicourethral anastomotic techniques in laparoscopic radical prostatectomy. World J Urol. 2008;26(6):617-622.

    Article  PubMed  Google Scholar 

  57. Secin FP, Touijer K, Mulhall J, Guillonneau B. Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol. 2007;51(5):1229-1235.

    Article  PubMed  Google Scholar 

  58. Gargollo Patricio C, Dahl Douglas M. Complications of laparoscopic radical prostatectomy. In: Loughlin KR, ed. Complications of Urologic Surgery and Practice: Diagnosis, Prevention, and Management. 2nd ed. New York: Informa Healthcare USA, Inc; 2007:349. 52 Vanderbilt Avenue, New York, NY 10017.

    Chapter  Google Scholar 

  59. Bhayani SB, Pavlovich CP, Strup SE, et al. Laparoscopic radical prostatectomy: a multi-institutional study of conversion to open surgery. Urology. 2004;63(1):99-102.

    Article  PubMed  Google Scholar 

  60. Rassweiler J, Schulze M, Teber D, Seemann O, Frede T. Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol. 2004;14(2):75-82.

    Article  PubMed  Google Scholar 

  61. Rassweiler J. Open vs. laparoscopic radical prostatectomy … and laparoscopy is better! Eur Urol. 2006; 50(1):26-28.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Massachusetts General Hospital, GRB 110255 Fruit Street, Boston, 02114, MA, USA

    Sarah P. Psutka

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  1. Sarah P. Psutka
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  2. Douglas M. Dahl
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Correspondence to Sarah P. Psutka .

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Editors and Affiliations

  1. , Urology and Wilmot Cancer Center, University of Rochester Medical Center, Elmwood Avenue 601, Rochester, 14642, New York, USA

    Jean V. Joseph

  2. Department of Surgery, Endocrine, University Hospital of North Norway, Tromsø, 9038, Norway

    Hitendra R.H. Patel

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Psutka, S.P., Dahl, D.M. (2011). Extraperitoneal Laparoscopic Radical Prostatectomy. In: Joseph, J., Patel, H. (eds) Retroperitoneal Robotic and Laparoscopic Surgery. Springer, London. https://doi.org/10.1007/978-0-85729-485-2_12

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  • DOI: https://doi.org/10.1007/978-0-85729-485-2_12

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