Demirtas–Erciyes Modification of Laparoscopic Transperitoneal Radical Prostatectomy

Abstract

Objective:

Minimally invasive surgery, especially robot-assisted laparoscopic prostatectomy (RARP), stands out among the current treatments in localized prostate cancer (PCA). RARP is technically advantageous because it enables the bladder neck and urethra protection to be more possible. However, since robotic systems are not always available, laparoscopic radical prostatectomy is still up to date. In this video report, we present our laparoscopic radical prostatectomy technique, which is a combination of Montsouris' technique and bladder neck and urethra preservation described for RARP by Cathelineau et al.¹ and Tunç et al.²

Materials and Methods:

Data of 160 patients who were operated between July 2015 and December 2020 for localized PCA were analyzed retrospectively. Demirtas–Erciyes modification of laparoscopic transperitoneal radical prostatectomy (DE-LAP) technique could not be applied to 43 patients because of history of transurethral resection of prostate or presence of the median lobe protruding into the bladder. Preoperative prostate-specific antigen, prostate biopsies, preoperative erectile function status, operation time, transfusion rate, complications, pathology results of laparoscopic retropubic radical prostatectomy, postoperative erectile function, and continence status were recorded. Details of the surgical technique that was described previously by Tombul et al.³ are given in the video.

Results:

The mean age of 117 patients was 64.5 ± 4.8 years old. In total, 73.7% of the patients had low-risk PCA according to the European Association of Urology Guideline on prostate cancer.⁴ The median operation time was 185 minutes. Lymph node dissection was performed in 24 patients (19.6%). Nerve sparing was performed in 74 patients (60.6%). Surgical margin positivity, extracapsular extension, and seminal vesicle invasion were detected in 11 (9%), 12 (9.8%), and 5 patients (4.1%), respectively. Rectal injury in three patients, ureter ligation in one patient, bladder perforation in one patient, and bladder neck stricture in five patients were detected. Continence rates at postoperative 3rd, 6^th, and 12th month were 84%, 94.7%, and 97%, respectively. Spontaneous or assisted erection was observed in half of the patients in whom nerve sparing was done.

Conclusion:

DE-LAP stands out as a method that can be preferred among the minimally invasive treatment options of PCA.

The authors have no existing financial competing interests. There is no financial support for this study

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Runtime of video: 7 mins 56 secs

The video submitted here was presented before in 14th National Endourology Congress in Turkey held online between April 1st and 4th 2020. In this congress, our video abstract has won 3rd prize for the best video abstracts.

Keywords

prostate cancer laparoscopy radical prostatectomy

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References

Cathelineau

, Sanchez-Salas

, Barret

, et al. Radical prostatectomy: Evolution of surgical technique from the laparoscopic point of view. Int Braz J Urol, 2010; 36:129–139; discussion 140.

Tunç

, Gumustas

, Akin

, Atkin

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, Erdem

, Bozkirli

. A novel surgical technique for preserving the bladder neck during robot-assisted laparoscopic radical prostatectomy: Preliminary results. J Endourol, 2015; 29:186–191.

Tombul

ŞT

, Sönmez

, Demirtaş

. Laparoscopic radical prostatectomy with a bladder neck and urethra preservation modified posterior approach: Short-term oncological and functional results of the first 108 patients. J Urol Surg, 2020; 7:309–315.

Mottet

, Bellmunt

, Bolla

, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol, 2017; 71:618–629.