Laparoscopic Radical Prostatectomy: The Technique

Abstract

Radical prostatectomy (RP) is the most effective treatment for localized prostate cancer and the treatment recommended by the majority of urologists to their patients [1]. The retropubic route is most commonly used as the anatomy is more familiar and it allows synchronous pelvic lymphadenectomy and always permits removal of a large prostate intact. In contrast with perineal prostatectomy, the retropubic approach is not associated with an incidence of postoperative fecal incontinence. The motivation behind developing laparoscopic RP (LRP) lay in the wish to expand the number of patients who might benefit from the claimed generic advantages of laparoscopic surgery, namely, less postoperative pain and a shorter convalescence. LRP also appeared to greatly reduce intraoperative blood loss and provided the surgeon with a consistently evenly illuminated and magnified view of the pelvic anatomy and suggested the possibility of superior results through superior vision. Subsequent publications have quashed this hope [2] and have demonstrated a clear link between surgical volume and patient outcomes but no advantage of LRP or robot-assisted LRP in terms of oncological or functional superiority.