Abstract
Purpose: The laparoscopic technique is now applied to radical prostatectomy. However, even
in laparoscopic prostatectomy, we need a small open wound to remove the prostate from
the abdomen. We have developed a modified technique of extraperitoneal laparoscopic
radical prostatectomy, exploiting this small open wound as a route for surgical manipulations
as well. Here, we described our technique and its initial outcomes. Patients and Methods: An extraperitoneal retropubic space was developed with finger manipulations through
a 3- to 5-cm long suprapubic incision. Three or four trocar ports were set up. A specially
designed abdominal wall-lifter was applied to create an endoscopic working space.
The surgeons worked using open or endoscopic manipulations through the suprapubic
incision or the trocar ports. From October 2000 to August 2001, 11 patients with prostate
cancer underwent this surgery. Results: We completed surgery endoscopically without major complications except in one case
in which we could not identify a bleeding source. Surgical time ranged from 229 to
469 min. Blood loss ranged from 550 to 3797 ml including urine spilled in the surgical
field. Urinary continence returned in 10 cases at 1 to 8 months after surgery. One
patient still needed pads at 3 months after surgery. Conclusion: Our technique allowed us to avoid insufflation of the abdomen with gas and intraperitoneal
surgical intervention that are disadvantages of conventional laparoscopic prostatectomy,
offering the same advantages as conventional laparoscopic prostatectomy.
Key words
Gasless laparoscope - radical prostatectomy - extraperitoneal approach
References
porco@med.nihon-u.ac.jp
