Laparoscopic radical prostatectomy: the initial UK series.

OBJECTIVE: To test the reproducibility of other series of laparoscopic radical prostatectomy (LRP) for safety, efficacy and early oncological and functional results. PATIENTS AND METHODS: One hundred consenting patients with clinically localized adenocarcinoma of the prostate and a Gleason sum of < or = 8 opting for surgery underwent LRP undertaken by one surgeon. Their mean (range) age was 62.2 (52-72) years, weight 78.8 (65-100) kg, prostate specific antigen (PSA) level 8.0 (2-32) ng/mL, and Gleason sum 6.0 (4-8). A five-port antegrade transperitoneal technique was used in all cases. RESULTS: The mean (range) operative duration was 245 (145-600) min, blood loss 313 (50-1300) mL, parenteral morphine sulphate administration 20.2 (0-160) mg and hospital stay after LRP 4.2 (3-13) nights. Bilateral neurovascular bundle preservation was attempted in 58% of patients. The transfusion rate was 3%. The conversion and re-intervention rates were 1% and 2%, respectively. There were eight complications, six of which were in the initial 26 cases, i.e. bladder neck stenosis (two), and rectal injury, laparotomy for bleeding, premature drain removal leading to urinary peritonitis, ulnar nerve neuropraxia, port-site hernia and paralytic ileus in one each. The positive surgical margin rate was 16%. All patients had a PSA level of < or = 0.1 ng/mL at 3 months. By 1 year 90% of patients were pad-free and 62% operated on using a bilateral nerve-sparing technique had erections. There were no biochemical failures. The mean (range) follow-up was 9.8 (1-24) months. CONCLUSION: The present results are similar to those reported by other centres with greater experience and confirm that LRP is an effective, safe and precise technique. Once intial experience has been gained it offers advantages over open surgery in the form of a dry and magnified operative site, and a lower likelihood of blood transfusion, in addition to the generic advantages of laparoscopy.

Unusual cause for acute retention of urine.

Acute retention of urine occurs uncommonly in women. One of the more common causes has been labelled psychogenic. Postoperative urinary retention is seen infrequently, particularly after pelvic and anal surgery. Rare causes include complete procidentia, vesical herpes zoster, bladder stone and bladder tumours with or without clot retention.

Open versus laparoscopic cholecystectomy: a comparison of postoperative temperature.

Laparoscopic cholecystectomy has been shown to allow better postoperative pulmonary function than open cholecystectomy, with less incidence of lung atelectasis. As atelectasis following abdominal surgery is responsible for most febrile episodes in the first 48 h, it was postulated that with minimally invasive surgery there may be a parallel improvement in the incidence of postoperative fever. This study was designed to evaluate this hypothesis. Seventy-eight patients were randomly divided into two groups. Thirty-eight had an open cholecystectomy and 40 underwent the laparoscopic approach. Twenty-one of the 38 patients (55%) following open cholecystectomy had early febrile episodes compared with only 6 of the 40 (15%) in the laparoscopic cholecystectomy group. We concluded that there was a lower incidence of febrile episodes following laparoscopic cholecystectomy and suggest that this was related to improved pulmonary function and minimal surgical trauma.

Needle prick injury to the surgeon--do we need sharp needles?

Needle prick injury is a well known hazard for surgeons and their assistants. This carries a risk of transmitting HIV and hepatitis infection. In this study the high incidence of sharp needle injury was confirmed (18.9%), with more than one third (8.7%) resulting in skin puncture. The highest incidence of injury occurred during hernia repair (27%) and abdominal wound closure (52%), where injury was sustained to the left index and middle finger as would be expected in right-handed surgeons. Blunt-tipped needles were used in 78 different procedures with technically satisfactory outcome particularly in abdominal wall wound closure and hernia repair, and even in colonic anastomosis, only two glove injuries were reported, with no skin injury. We concluded that the used of blunt-tipped needles is a practical option in eliminating needle prick injury to surgeon's hands.