Laparoscopic Radical Prostatectomy in Srinagarind Hospital

: Initial experience
Wichien Sirithanaphol, MD Ekkarin Chotikawanich, MD

Background
Radical Prostatectomy (RPP) is a curative treatment of localized prostatic cancer Nowadays, more complex urological operation for this procedure is done with laparoscopy
Laparoscopic radical prostatectomy (LRP) was first described in 1991

Background
Laparoscopic radical prostatectomy has gained more popularity use in many centers
Minimally invasive approach less pain and fast recovery Magnifying effect sparing of muscle and neurovascular structures

The limitations of laparoscopic prostatectomy are related to its steep learning curve and long mean operative times

Background
In this study, we describe 9 initial case treated by Laparoscopic Radical Prostatectomy

Objective
To determine the feasibility and efficacy of a Laparoscopic Radical Prostatectomy in Srinagarind Hospital

Material and methods

Between August 2008 and January 2009
Nine patients with clinically localized and TRUS Biopsy proved prostate cancer underwent laparoscopic radical prostatectomy in Srinagarind Hospital

Material and methods

Patient characteristics, perioperative data and pathological results were recorded All patients had one-month follow up

Operative Technique
Trendelenburg position A foley catheter is inserted Trans-peritoneal approach Laparoscopic access is provided with five trocars The urethro-vesical anastomosis was performed with running technique Cystography was done routinely and the catheter was removed if there was no leakage

Results

Pt (No.)
1 2

Age
60 61

Underlying disease
HT Umbilical hernia DM,HT

Previous surgery
-

ASA score
2 2

3 4 5
6 7

76 67 72
67 74

HT
HT Gout anemia

2 2 2
2 2

70

Pulmonary TB Bilateral RC Right DIH HT, RBBB 1st degree AV block

Open cholecystectomy TUR-P TUR-P

68

68

Pt (No.)
1 2 3 4 5

Symptoms
Check up Check up Check up Obstruction Frequency

PR (grade)
3 3 3 3 3

PSA level (ng/ml)

29.72 27.47 7.98 5.53 4.57

Gleason score
6 5 5 6 6

6 7
8 9

Frequency Frequency
Obstruction Frequency Obstruction

3 3
3 3

7.09 20
44.89 9.41

4 3
7 6

17.4

5.3

Pt (No.) 1 2

Procedure LRP Open RPP LRP + Open suture

Cause of open procedure Uncertain of bladder neck position Bleeding and poor exposure of anastomosis

3
4 5 6

LRP
LRP LRP LRP

7
8 9

LRP
LRP + TAPP LRP

Pt (No.) 1 2 3 4 5 6

Operative time (min) 400 660 390 420 360 360

Blood loss (ml) 1,200 1,500 450 1,200 650 1,000

Intra-operative complication Bladder injury -

Therapy -

Primary repair -

7 8 9

390 285 405 407

300 450 1,120 870

Rectal injury -

Primary repair -

Pt (No.) 1

Anastomosis leakage No

Retained catheter (day) 7

2 3
4 5 6 7 8

Yes No
No No No No Yes

48 14
8 13 14 7 10

Yes

Pt (No.) 1

Urination -

Erectile dysfunction Yes

2 3
4 5 6 7 8

Urethral stricture Urgency

Urgency Frequency Urgency Urgency

Yes Yes
Yes Yes Yes Yes Yes

Urgency

Yes

Pt (No.) 1

Prostate gland (gm) -

Free margin

Gleason (ng/ml) 6

Gleason Pre-op
6

yes

2 3
4 5 6 7 8

40 25
55 65 29 20 23

yes yes
yes yes No No No

5 5
6 6 5 8 7

5 5
6 6 4 3 7

70 40

No

6 6

6 5.3

Pt (No.) 1

PSA level (Pre-op)

29.72

PSA level (Post-op) 0.07

2 3
4 5 6 7 8

27.47 7.98
5.53 4.57 7.09 20 44.89

0.004 0.43
0.028 0.028 0.015 0.392 2.28

9.41

0.601 0.46

17.4

Pt (No.) 1 2

Pain score (24 h) 5 5

Blood Transfusion (unit) 0 0

Pos op stay (day) 8 3

3 4 5
6 7 8 9

4 5 3
3 5 4 2 4

0 3 1
1(pre-op) 0 0 2 0.7

5 20 5
10 4 12 6 8.1

Comments
Laparoscopic Radical Prostatectomy is a difficult and challenging procedure with a long learning curve The morbidity of our first case series is slightly high

Comments
As a result, the practice in techniques and skills need to be improved for a better outcome In our opinion, Laparoscopic Radical Prostatectomy will be the future method of choice for Radical Prostatectomy

Thank You