Laparoscopic Prostatectomy and Pelvic Lymph Node Dissection

  • Itay Sternberg
  • Guilherme Maia
  • Abdelkarim Touijer
  • Bertrand D. Guillonneau


Radical prostatectomy is one of the most challenging operations in urology: it is all together a cancer treatment for which a suboptimal surgery may lead to late cancer recurrence that will impair overall life expectancy and a functional procedure whose suboptimal care will impact patient’s quality of life infinitively. In this sense, radical prostatectomy is highly dependent on the expertise and experience of the surgeon. Laparoscopic approach was thought to improve both functional and possibly oncologic outcomes. With more than 15 years of follow-up, one can state that for well-trained surgeon, results are comparable to those obtained by well-experienced open surgeon, with some clear benefits in terms of perioperative bleeding, convalescence, and bladder neck stenosis. For these reasons, laparoscopic surgery, with or without robotic assistance, will continue to spread into the urologic community. But this development should be accompanied within a comprehensive training program; otherwise, the benefits will be counterbalanced by unacceptable rate of complications, definitive functional side effects, and cancer recurrence.


Radical Prostatectomy Estimate Blood Loss Erectile Function Positive Surgical Margin Pelvic Lymph Node Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Guillonneau B, et al. Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol. 1999;36(1):14–20.PubMedCrossRefGoogle Scholar
  2. 2.
    Touijer K, et al. Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005. J Urol. 2008;179(5):1811–7. discussion 1817.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Schmeller N, Keller H, Janetschek G. Head-to-head comparison of retropubic, perineal and laparoscopic radical prostatectomy. Int J Urol. 2007;14(5):402–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Rassweiler J, et al. Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol. 2003;169(5):1689–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Park S, et al. Contemporary laparoscopic and open radical retropubic prostatectomy: pathologic outcomes and Kattan postoperative nomograms are equivalent. Urology. 2007;69(1):118–22.PubMedCrossRefGoogle Scholar
  6. 6.
    Coelho RF, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol. 2010;24(12):2003–15.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Djavan B, et al. Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates. BJU Int. 2012;110(1):69–75.PubMedCrossRefGoogle Scholar
  8. 8.
    Rabbani F, et al. Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol. 2010;57(3):371–86.PubMedCrossRefGoogle Scholar
  9. 9.
    Wagner AA, et al. Comparison of open and laparoscopic radical prostatectomy outcomes from a surgeon’s early experience. Urology. 2007;70(4):667–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Catalona WJ, Smith DS. Cancer recurrence and survival rates after anatomic radical retropubic prostatectomy for prostate cancer: intermediate-term results. J Urol. 1998;160(6 Pt 2):2428–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol. 1999;17(5): 1499–507.PubMedGoogle Scholar
  12. 12.
    Stamey TA, et al. Biological determinants of cancer progression in men with prostate cancer. JAMA. 1999;281(15):1395–400.PubMedCrossRefGoogle Scholar
  13. 13.
    Guillonneau B, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute. J Urol. 2003;169(4):1261–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Eden CG, Neill MG, Louie-Johnsun MW. The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple ‘learning curves’. BJU Int. 2009;103(9):1224–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Paul A, et al. Oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm follow-up of 1115 procedures. Eur Urol. 2010;57(2): 267–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Lepor H, Nieder AM, Ferrandino MN. Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol. 2001;166(5):1729–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Vickers A, et al. The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point. J Urol. 2010;183(4):1360–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Busch J, et al. Impact of positive surgical margins on oncological outcome following laparoscopic radical prostatectomy (LRP): long-term results. World J Urol. 2013;31(2):395–401.PubMedCrossRefGoogle Scholar
  19. 19.
    Secin FP, et al. Preoperative and intraoperative risk factors for side-specific positive surgical margins in laparoscopic radical prostatectomy for prostate cancer. Eur Urol. 2007;51(3):764–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Kordan Y, et al. Impact of positive apical surgical margins on likelihood of biochemical recurrence after radical prostatectomy. J Urol. 2009;182(6): 2695–701.PubMedCrossRefGoogle Scholar
  21. 21.
    Pettus JA, et al. Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location. J Urol. 2004;172(1): 129–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Stephenson AJ, et al. Location, extent and number of positive surgical margins do not improve accuracy of predicting prostate cancer recurrence after radical prostatectomy. J Urol. 2009;182(4):1357–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Mazzola C, et al. Nodal counts during pelvic lymph node dissection for prostate cancer: an objective indicator of quality under the influence of very subjective factors. BJU Int. 2012;109(9):1323–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Cooperberg MR, et al. Time trends in clinical risk stratification for prostate cancer: implications for outcomes (data from CaPSURE). J Urol. 2003;170(6 Pt 2):S21–5; discussion S26-7.PubMedCrossRefGoogle Scholar
  25. 25.
    Silberstein JL, et al. Reverse stage shift at a tertiary care center: escalating risk in men undergoing radical prostatectomy. Cancer. 2011;117(21):4855–60.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Stolzenburg JU, et al. Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases. J Endourol. 2009;23 (9):1467–72.PubMedCrossRefGoogle Scholar
  27. 27.
    Touijer K, et al. Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity? BJU Int. 2011;108(3):372–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Touijer K, et al. Oncologic outcome after laparoscopic radical prostatectomy: 10 years of experience. Eur Urol. 2009;55(5):1014–9.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Touijer K, et al. Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1 %. J Urol. 2007;178(1):120–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Hruza M, et al. Long-term oncological outcomes after laparoscopic radical prostatectomy. BJU Int. 2013; 111(2):271–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Busch J, et al. Long-term oncological and continence outcomes after laparoscopic radical prostatectomy: a single-centre experience. BJU Int. 2012;110(11 Pt C):E985–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Ploussard G, et al. Prospective evaluation of combined oncological and functional outcomes after laparoscopic radical prostatectomy: trifecta rate of achieving continence, potency and cancer control at 2 years. BJU Int. 2011;107(2):274–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Menard J, et al. Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology. 2008;72(3): 593–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Teber D, et al. Laparoscopic radical prostatectomy in clinical T1a and T1b prostate cancer: oncologic and functional outcomes—a matched-pair analysis. Urology. 2009;73(3):577–81.PubMedCrossRefGoogle Scholar
  35. 35.
    Eggleston JC, Walsh PC. Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases. J Urol. 1985;134(6):1146–8.PubMedGoogle Scholar
  36. 36.
    Walsh PC, Mostwin JL. Radical prostatectomy and cystoprostatectomy with preservation of potency. Results using a new nerve-sparing technique. Br J Urol. 1984;56(6):694–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Secin FP, et al. Anatomy of accessory pudendal arteries in laparoscopic radical prostatectomy. J Urol. 2005;174(2):523–6; discussion 526.PubMedCrossRefGoogle Scholar
  38. 38.
    Secin FP, et al. Positive surgical margins and accessory pudendal artery preservation during laparoscopic radical prostatectomy. Eur Urol. 2005;48(5):786–92; discussion 793.PubMedCrossRefGoogle Scholar
  39. 39.
    Salomon L, et al. Urinary continence and erectile function: a prospective evaluation of functional results after radical laparoscopic prostatectomy. Eur Urol. 2002;42(4):338–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Su LM, et al. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology. 2004;64(1):123–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Taniguchi H, et al. Recovery of erectile function after nerve-sparing laparoscopic radical prostatectomy in Japanese patients undergoing both subjective and objective assessments. J Sex Med. 2012;9(7):1931–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Roumeguere T, et al. Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol. 2003;20(6):360–6.PubMedGoogle Scholar
  43. 43.
    Bianco Jr FJ. P.T. Scardino, and J.A. Eastham, Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”). Urology. 2005;66(5 Suppl):83–94.PubMedCrossRefGoogle Scholar
  44. 44.
    Chade DC, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol. 2011;60(2):205–10.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Vallancien G, et al. Initial results of salvage laparoscopic radical prostatectomy after radiation failure. J Urol. 2003;170(5):1838–40.PubMedCrossRefGoogle Scholar
  46. 46.
    Liatsikos E, et al. Treatment of patients after failed high intensity focused ultrasound and radiotherapy for localized prostate cancer: salvage laparoscopic extraperitoneal radical prostatectomy. J Endourol. 2008;22(10):2295–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Ahallal Y, et al. Pilot study of salvage laparoscopic prostatectomy for the treatment of recurrent prostate cancer. BJU Int. 2011;108(5):724–8.PubMedGoogle Scholar
  48. 48.
    Secin FP, et al. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol. 2010;184(6):2291–6.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Vickers AJ, et al. The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol. 2009;10(5):475–80.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Galli S, et al. Oncologic outcome and continence recovery after laparoscopic radical prostatectomy: 3 years’ follow-up in a “second generation center”. Eur Urol. 2006;49(5):859–65.PubMedCrossRefGoogle Scholar
  51. 51.
    Guillonneau B, et al. Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol. 2002;43(2):123–33.PubMedCrossRefGoogle Scholar
  52. 52.
    Goeman L, et al. Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol. 2006;24(3):281–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Itay Sternberg
    • 1
  • Guilherme Maia
    • 2
  • Abdelkarim Touijer
    • 1
  • Bertrand D. Guillonneau
    • 2
  1. 1.Department of UrologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of UrologyDiaconesses-Croix St. Simon HospitalParisFrance

Personalised recommendations