Lateral view dissection of the prostato-urethral junction to reduce positive apical margin in laparoscopic radical prostatectomy.

OBJECTIVE

To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence.

METHODS

One hundred and forty-four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato-urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups.

RESULTS

Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso-apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P < 0.001), respectively. Postoperative recovery of urinary continence improved significantly, with a pad-free rate over the first 3 months of 55.9% in Group 1 vs 71.7% in Group 2 (P = 0.01). Multivariate logistic regression analysis showed this modified surgical technique to predict a lower rate of positive margins.

CONCLUSION

Lateral view dissection of the prostato-urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.