RESUMO
Since the first laparoscopic prostatectomies, performed via an intraperitoneal approach in Bordeaux, France, in November 1997 (Gaston et al.) and then via an extraperitoneal approach in Belgium in September 1999 (BOLLENS et al.), several French (Montsouris and Mondor) and European teams have adopted and amplified these approaches, but much late and more discreetly in the case of the extraperitoneal approach. A multidisciplinary collaboration initiated in Lyon in 1999 has led to the development of an original retrograde extraperitoneal laparoscopic technique (R.E.L.P.) which exactly reproduces the conventional open operation and which allows primary access and dissection of the erectile neurovascular pedicles and the prostatic-urethral sphincter junction, followed by retrograde prostato-rectal dissection. This technique, based on a series of 143 operations at the end of 2002, which exclusively uses an oblique vision scope, comprises the following steps: 1. Access to and exposure of the surgical field, an essential step which determines the success of the rest of the operation. 2. Primary or secondary pelvic lymphadenectomy. 3. Primary access to the erectile neurovascular pedicles and prostatic-urethral sphincter junction, which, together with the following step, represents the original feature of this technique. 4. Urethral section and retrograde prostato-rectal and seminal dissection. 5. Vesico-prostatic cleavage, and antegrade dissection of the seminal vesicles and vesico-prostatic attachments. 6. Vesicourethral anastomosis by interrupted sutures tied extracorporeally. The still limited preliminary results are very encouraging and will soon be reviewed with a longer follow-up, which should show that the retrograde extraperitoneal approach is a technique of choice for laparoscopic radical prostatectomy.
