Initial experience with extraperitoneal monopolarless laparoscopic radical prostatectomy in a secondary hospital of Greece

Iason Kyriazis, Dimitrios Dimitriou, Markos Karavitakis, Evangelos Liatsikos, Anastasios Thanos


Aim of the study: To report the prospectively collected outcomes
of our initial experience with laparoscopic radical prostatectomy in
a secondary hospital of Greece.
Materials and methods: In total 15 cases with localized prostate cancer
(3x low risk, 5x intermediate risk and 7x high risk) and a mean age of 70
years (range 58-79) were operated during a 9 month period in our department.
All operations were performed by a single laparoscopic surgeon
under the supervision of two senior experienced open surgeons and the
assistance of an assistant experienced in laparoscopic prostatectomy.
Results: No case was converted into open surgery. Mean operating
time (OT) dropped gradually from 5.5 hours in the beginning of our
experience to up to 2 hours with a mean OT of 3.2 hours including 6
cases where a pelvic lymph node dissection was deemed necessary.
Blood loss was minimum in all cases and no transfusion was required.
All but 3 cases (80%) were discharged on the first postoperative day
and catheter was removed 5 days later under cystographic verification
of anastomotic water tightness in the vast majority of cases. Positive
surgical margins (PSMs) were present in 5 patients (33%). Immediate
continence after catheter removal was evident in 53% of our cases and
early continence (continent within 2weeks from catheter removal) in
60%. Out of 10 patients having completed a 3month follow-up, 80%
(8/10) were pad free. Both two incontinent patients still use 1 pad per
day and include one case with immediate continence which started
leaking after salvage radiotherapy initiation. PSA failure (>0.2ng/
dL) at 3 months was evident in 3 (30%) of patients including one
patient operated with a PSA of 136ng/dL and two patients without
PSMs. All these cases were included in the first 6 operated cases and
were scheduled for salvage radiation treatment. At a mean of 56 days
post prostatectomy, potency was restored in 3 patients following a
penile rehabilitation protocol after surgery while none of the rest of
patients requested further treatment for impotency.
Conclusions: In the hands of a well-trained surgical group, perioperative
morbidity of laparoscopic radical prostatectomy during the initial phases
of learning curve is minimum. Early continence outcomes can reach
comparative levels with the high volume center literature after the very
first cases. Initial oncological outcomes were inferior to the published literature
yet they were most likely due to case selection (older patients with
adverse pathology) than due to limitations of the operative technique.


Prostate Cancer;Laparoscopic;Radical Prostatectomy;Learning curve

Full Text:



Catalona WJ, Ramos CG, Carvalhal GF. Contemporary results of

anatomic radical prostatectomy. CA Cancer J Clin. 1999 Sep-


Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic,

and robot-assisted radical prostatectomy: a systematic review

and cumulative analysis of comparative studies. Eur Urol. 2009


Caras RJ, Lustik MB, Kern SQ, et al. Laparoscopic radical prostatectomy

demonstrates less morbidity than open radicalprostatectomy:

an analysis of the American College of Surgeons-National Surgical

Quality Improvement Program database with a focus on surgical

trainee involvement. J Endourol. 2014 Mar;28(3):298-305.

Mottet N, Bellmunt J2, Bolla M3, et al. EAU-ESTRO-SIOG Guidelines

on Prostate Cancer. Part 1: Screening, Diagnosis, and Local

Treatment with Curative Intent. Eur Urol. 2017 Apr;71(4):618-629.

Stolzenburg JU, Rabenalt R, Do M, et al. Modular training for

residents with no prior experience with open pelvic surgery in

endoscopicextraperitoneal radical prostatectomy. Eur Urol. 2006


Vallancien G, Cathelineau X, Baumert H, et al. Complications of

transperitoneal laparoscopic surgery in urology: review of 1,311

procedures at a single center. J Urol. 2002 Jul;168(1):23-6.

Secin FP, Savage C, Abbou C, et al. The learning curve for laparoscopic

radical prostatectomy: an international multicenter study.

J Urol. 2010 Dec;184(6):2291-6.

Haglind E, Carlsson S, Stranne J, et al. Urinary Incontinence and

Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy:

A Prospective, Controlled, Nonrandomised Trial. Eur Urol.


Lei Y, Alemozaffar M, Williams SB, et al. Athermal division and

selective suture ligation of the dorsal vein complex during robot-

assisted laparoscopic radical prostatectomy: description of

technique and outcomes. Eur Urol. 2011 Feb;59(2):235-43.

Li K, Li H, Yang Y, et al. Risk factors of positive surgical margin and

biochemical recurrence of patients treated with radical prostatectomy:

a single-center 10-year report. Chin Med J (Engl). 2011