Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G
Department of Urology, Institut Mutualiste Montsouris, Paris, France.
Eur Urol. 1999;36(1):14-20. doi: 10.1159/000019921.
To evaluate the technical feasibility, oncological efficacy and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy.
We describe an original technique of laparoscopic radical prostatectomy performed in 40 patients between 26th January and 12th October, 1998.
Radical prostatectomy was performed entirely by laparoscopy in 35 patients (87.5%) and only one conversion was performed in the last 26 patients (4%). Pelvic lymphadenectomy was performed in the light of preoperative staging data in 14 patients (35%). The median total operating time was 270 min. The only major complication was a rectal injury (patient 8), sutured laparoscopically with an uneventful postoperative course. Postoperative vesical catheterization lasted an average of 7.65 days. Seven patients were transfused (17.5%) with an average of 2.8 units of packed cells (range: 2-3). The reduction of postoperative pain is an element allowing for a rapid discharge of the patients by the 3rd postoperative day. The oncological results were as follows: 36 patients had a pT2 tumor (90%); prostate tumor was staged as N0 in 14 cases and NX in 26 cases. Surgical margins were negative in 33 patients (82.5%). Two patients had a doubtful resection margin (1 at the apex and 1 at the bladder neck) and 5 patients had positive margins. The last PSA level was undetectable (<0.1 ng/ml) in 26 (89.7%) of the 29 patients in whom PSA level was available more than 1 month after the operation. Functional results are not yet available and will be published later.
Radical prostatectomy is an operation which can be routinely performed by laparoscopy by a team experienced with this technique. Operative and postoperative morbidity was low. Short-term oncological data appear identical to the results of conventional retropubic surgery. The improvement of operative visibility was considerable allowing a much more precise dissection. The laparoscopic approach appears to represent a technical improvement of the radical prostatectomy if the functional results of this operation improve parallel to the quality of dissection. A long-term follow-up is needed to define definitively the place of this new approach to radical prostatectomy.
评估腹腔镜根治性前列腺切除术的技术可行性、肿瘤学疗效以及术中及术后并发症发生率。
我们描述了1998年1月26日至10月12日期间对40例患者实施的腹腔镜根治性前列腺切除术的原始技术。
35例患者（87.5%）完全通过腹腔镜完成根治性前列腺切除术，在最后26例患者中仅1例中转（4%）。根据术前分期数据，14例患者（35%）进行了盆腔淋巴结清扫术。中位总手术时间为270分钟。唯一的主要并发症是直肠损伤（第8例患者），通过腹腔镜缝合，术后过程顺利。术后膀胱导尿平均持续7.65天。7例患者输血（17.5%），平均输入2.8单位浓缩红细胞（范围：2 - 3单位）。术后疼痛减轻使得患者在术后第3天即可快速出院。肿瘤学结果如下：36例患者为pT2期肿瘤（90%）；前列腺肿瘤14例为N0期，26例为NX期。33例患者（82.5%）手术切缘阴性。2例患者切缘可疑（1例在尖部，1例在膀胱颈部），5例患者切缘阳性。在术后1个月以上可获得PSA水平的29例患者中，26例（89.7%）最后一次PSA水平检测不到（<0.1 ng/ml）。功能结果尚未得出，将在以后发表。
根治性前列腺切除术是一项经验丰富的团队可通过腹腔镜常规实施的手术。手术及术后并发症发生率低。短期肿瘤学数据似乎与传统耻骨后手术的结果相同。手术视野的改善相当显著，使得解剖更加精确。如果该手术的功能结果随着解剖质量的提高而改善，那么腹腔镜入路似乎代表了根治性前列腺切除术的技术改进。需要长期随访来明确这种根治性前列腺切除术新方法的地位。
