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World Journal of Urology

, Volume 24, Issue 6, pp 668–675 | Cite as

Complications of endoscopic extraperitoneal radical prostatectomy (EERPE): prevention and management

  • Jens-Uwe Stolzenburg
  • Robert Rabenalt
  • Minh Do
  • Benjamin Lee
  • Michael C. Truss
  • Alan McNeill
  • Martin Burchardt
  • Udo Jonas
  • Evangelos N. Liatsikos
Original Article

Abstract

Endoscopic extraperitoneal radical prostatectomy (EERPE) is a further advancement of minimal invasive surgery as it overcomes the limitations of laparoscopic (transperitoneal) RPE by the strictly extraperitoneal route of access combining the advantages of minimal invasive surgery with the advantages of an extraperitoneal procedure. Endoscopic extraperitoneal radical prostatectomy has many advantages but is not without complications. The aim of this review article is to describe the most common complications of this procedure. Complications associated with endoscopic extraperitoneal radical prostatectomy are: vascular injury—bleeding—haematoma, bowel injury, lymphocele, injury to the bladder—ureter, port site hernia, anastomotic leakage—stricture, obturator nerve injury—paralysis, gas embolism, catheter blockage, and miscellaneous like perineal pain, pubic osteitis, infection- urosepsis. The present review paper focuses on the identification and management of these complications The incidence of most complications directly correlates with the surgeons’ experience, and the various complications are related to technical errors rather than to the technique itself. The laparoscopist performing endoscopic/ laparoscopic radical prostatectomy should be aware of all these complications. He should be able to recognise promptly, treat efficiently, and ideally prevent these complications.

Keywords

Endoscopic extraperitoneal radical prostatectomy Complications Prevention Management Prostate cancer 

References

  1. 1.
    Bollens R, Vanden Bossche M, Roumeguere T, Damoun A, Ekane S, Hoffmann P, Zlotta AR, Schulman CC (2001) Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol 40:65–69CrossRefPubMedGoogle Scholar
  2. 2.
    Stolzenburg J-U, Rabenalt R, Do M, Ho K, Dorschner W, Waldkirch E, Jonas U, Schütz A, Horn L, Truss MC (2005) Endoscopic extraperitoneal radical prostatectomy (EERPE)—oncological and functional results after 700 procedures. J Urol 174:1271–1275CrossRefPubMedGoogle Scholar
  3. 3.
    Rozet F, Galiano M, Cathelineau X, Barret E, Cathala N, Vallancien G (2005) Extraperitoneal laparoscopic radical prostatectomy: a prospective evaluation of 600 cases. J Urol 174:908–911CrossRefPubMedGoogle Scholar
  4. 4.
    Lepor H, Kaci L (2003) Contemporary evaluation of operative parameters and complications related to open radical retropubic prostatectomy. Urology 62:702–706CrossRefPubMedGoogle Scholar
  5. 5.
    Gillitzer R, Melchior SW, Hampel C, Wiesner C, Fichtner J, Thüroff JW (2004) Specific complications of radical perineal prostatectomy: a single institution study of more than 600 cases. J Urol 172:124–128CrossRefPubMedGoogle Scholar
  6. 6.
    Weldon VE, Tavel FR, Neuwirth H (1997) Continence, potency and morbidity after radical perineal prostatectomy. J Urol 158:1470–1475CrossRefPubMedGoogle Scholar
  7. 7.
    Lance RS, Freidrichs PA, Kane C, Powell CR, Pulos E, Moul JW, McLeod DG, Cornum RL, Brantley Thrasher J (2001) A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group. BJU Int 87:61–65CrossRefPubMedGoogle Scholar
  8. 8.
    Lepor H, Nieder AM, Ferrandino MN (2001) Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol 166:1729–1733CrossRefPubMedGoogle Scholar
  9. 9.
    Catalona WJ, Carvalhal GF, Mager DE, Smith DS (1999) Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 162:433–438CrossRefPubMedGoogle Scholar
  10. 10.
    Dillioglugil Ö, Leibman BD, Leibman NS, Kattan MW, Rosas AL, Scardino PT (1997) Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 157:1760–1767CrossRefPubMedGoogle Scholar
  11. 11.
    Stolzenburg JU, Do M, Rabenalt R, Pfeiffer H, Horn L, Truss MC, Jonas U, Dorschner W (2003) Endoscopic extraperitoneal radical prostatectomy (EERPE)—initial experience after 70 procedures. J Urol 169:2066–2071CrossRefPubMedGoogle Scholar
  12. 12.
    Stolzenburg JU, Truss MC (2003) Technique of laparoscopic (endoscopic) radical prostatectomy. BJU Int 91:749–757CrossRefPubMedGoogle Scholar
  13. 13.
    Stolzenburg JU, Do M, Pfeiffer H, König F, Aedtner B, Dorschner W (2002) The endoscopic extraperitoneal radical prostatectomy (EERPE): technique and initial experience. World J Urol 20:48–55CrossRefPubMedGoogle Scholar
  14. 14.
    Stolzenburg JU, Truss MC, Do M, Rabenalt R, Pfeiffer H, Dunzinger M, Aedtner B, Stief CG, Jonas U, Dorschner W (2003) Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE)—technical improvements and development of a nerve-sparing, potency-preserving approach. World J Urol 21:147–152CrossRefPubMedGoogle Scholar
  15. 15.
    Stolzenburg JU, Truss MC, Bekos A, Do M, Rabenalt R, Stief CG, Hoznek A, Abbou CC, Neuhaus J, Dorschner W (2004) Does the extraperitoneal laparoscopic approach improve the outcome of radical prostatectomy? Curr Urol Rep 5:115–122PubMedGoogle Scholar
  16. 16.
    Ahlering TE, Eichel L, Chou D, Skarecky D (2005) Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation. Urology 65:994–997CrossRefPubMedGoogle Scholar
  17. 17.
    Cathelineau X, Cahill D, Widmer H, Rozet F, Baumert H, Vallancien G (2004) Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge. J Urol 171:714–716CrossRefPubMedGoogle Scholar
  18. 18.
    Remzi M, Klingler HC, Tinzl MV, Fong YK, Lodde M, Kiss B, Marberger M (2005) Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy versus open retropubic radical prostatectomy. Eur Urol 48:83–89CrossRefPubMedGoogle Scholar
  19. 19.
    Martina GR, Giumelli P, Scuzzarella S, Remotti M, Caruso G, Lovisolo J (2005) Laparoscopic extraperitoneal radical prostatectomy–learning curve of a laparoscopy-naive urologist in a community hospital. Urology 65:959–963CrossRefPubMedGoogle Scholar
  20. 20.
    Hoznek A, Antiphon P, Borkowski T, Gettman M, Katz R, Salomon L, Zaki S, de la Taille A, Abbou CC (2003) Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology 61:617–622CrossRefPubMedGoogle Scholar
  21. 21.
    van Velthoven RF (2005) Laparoscopic radical prostatectomy: transperitoneal versus retroperitoneal approach: is there an advantage for the patient? Curr Opin Urol 15:83–88CrossRefPubMedGoogle Scholar
  22. 22.
    Rassweiler J, Sentker L, Seemann O, Hatzinger M, Stock C, Frede T (2001) Heilbronn laparoscopic radical prostatectomy Technique and results after 100 cases. Eur Urol 40:54–64CrossRefPubMedGoogle Scholar
  23. 23.
    Guillonneau B, Gupta R, El Fettouh H, Cathelineau X, Baumert H, Vallancien G (2003) Laparoscopic management of rectal injury during radical prostatectomy. J Urol 169:1694–1696CrossRefPubMedGoogle Scholar
  24. 24.
    Bishoff JT, Allaf ME, Kirkels W, Moore RG, Kavoussi LR, Schroder F (1999) Laparoscopic bowel injury: incidence and clinical presentation. J Urol 161:887–890CrossRefPubMedGoogle Scholar
  25. 25.
    Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, Baumert H, Vallancien G (2002) Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 167:51–56CrossRefPubMedGoogle Scholar
  26. 26.
    Spaliviero M, Steinberg AP, Kaouk JH, Desai MM, Hammert WC, Gill IS (2004) Laparoscopic injury and repair of obturator nerve during radical prostatectomy. Urology 64:1030CrossRefPubMedGoogle Scholar
  27. 27.
    Stolzenburg JU, Schwaibold H, Bhanot SM, Rabenalt R, Do M, Truss M, Ho K, Anderson C (2005) Modular surgical training for Endoscopic Extraperitoneal Radical Prostatectomy (EERPE). BJU Int 96:1022–1027CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Jens-Uwe Stolzenburg
    • 1
  • Robert Rabenalt
    • 1
  • Minh Do
    • 1
  • Benjamin Lee
    • 2
  • Michael C. Truss
    • 3
  • Alan McNeill
    • 4
  • Martin Burchardt
    • 5
  • Udo Jonas
    • 5
  • Evangelos N. Liatsikos
    • 6
  1. 1.Department of UrologyUniversity of LeipzigLeipzigGermany
  2. 2.Department of Urology, Albert Einstein College of MedicineLong Island Jewish Medical CenterNew YorkUSA
  3. 3.Department of UrologyKlinikum DortmundDortmundGermany
  4. 4.Department of UrologyWestern General HospitalEdinburghScotland
  5. 5.Department of UrologyMedizinische Hochschule HannoverHannoverGermany
  6. 6.Department of UrologyUniversity of PatrasPatrasGreece

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