4 Hands/4 Ports Laparoscopic Radical Prostatectomy

Abstract

Introduction

Radical laparoscopic prostatectomy is a challenging procedure, which requires a steep learning curve and involves normally three operators. Consequently this is an expensive procedure due both to the time spent for surgery in the operating theatre and the number of operators involved. But time consumption and consequently money costs can be reduced thanks to the learning curve enhancement and, moreover, by reducing the number of operators involved. This work is based on the idea of performing laparoscopic prostatectomy with two operators only.

Material and Methods

Our cases are 124 radical laparoscopic prostatectomies, performed from January 2004 until April 2009; of these, 13 non-consecutive, were carried out with 2 operators and 4 ports. The first attempt - not totally successful due to time spent in the operating theatre and to some operational difficulty - was carried out as 60th procedure (learning curve was not complete). Once the method was applied as 103rd procedure, it could then be constantly implemented.

Results

We demonstrate that this option is feasible once the team performing the laparoscopic radical prostatectomy has acquired a good level in the learning curve. The outcomes are very interesting with regard to time consumption (205’ minutes: one minute more than the 3 operators/5 ports procedure) and early oncological and functional results.