ABSTRACT
OBJETIVOS: Presentar nuestra experienciainicial en la práctica de la prostatectomía radicallaparoscópica por via extraperitoneal. Se describe latécnica quirúrgica y se revisan las dificultades técnicas,los costes de tiempo y las complicaciones.MÉTODOS: Entre Enero y Mayo de 2005 hemos indicado17 prostatectomías radicales laparoscópicas porvia extraperitoneal en nuestro centro. Dos de ellas serealizaron con ayuda de un maestro. La técnica empleada,de la que se hace una somera descripción, es lade Bruselas.RESULTADOS: De las 17 cirugías, se ha completado elprocedimiento íntegramente por laparoscopia en ochocasos. De los casos realizados sin ayuda externa y queson los que se analizan en este trabajo, 6 han sido íntegramentelaparoscópicos y 9 han requerido reconversión a cirugía abierta. De los últimos 6 únicamente sereconvirtió 1. El tiempo quirúrgico medio ha sido 304minutos (355 para las completadas por laparoscopia).La tasa de transfusión es del 13% . Los márgenes positivoshan sido del 26% (16% en los laparoscópicospuros). No ha habido complicaciones mayores ni íleosparalíticos prolongados. En un caso se tuvo que recolocarla sonda a los 7 días de la intervención. La reconversiónde la vía extraperitoneal a cirugía abierta no escompleja al no estar abierta la cavidad peritoneal perorequiere de experiencia previa en cirugía abierta puestoque los planos no se observan con facilidad.CONCLUSIONES: La prostatectomía radical laparoscópicaextraperitoneal es factible en un centro de nuestrascaracterísticas siempre y cuando se disponga deun equipo con experiencia previa en laparoscopia yse este dispuesto a invertir un considerable esfuerzoespecialmente en lo que respecta al número de horasde quirófano. El aprendizaje no se ha traducido encomplicaciones importantes
OBJECTIVES: Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. METHODS: From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. RESULTS: Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. CONCLUSIONS: ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication
Subject(s)
Male , Aged , Middle Aged , Humans , Adenocarcinoma/surgery , Laparoscopy/methods , Prostatectomy/methods , Prostatic Neoplasms/surgery , PeritoneumABSTRACT
OBJECTIVES: Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. METHODS: From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. RESULTS: Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. CONCLUSIONS: ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication.
