Initial experience with extraperitoneal monopolarless laparoscopic radical prostatectomy in a secondary hospital of Greece

Aim of the study: To report the prospectively collected outcomes of our initial experience with laparoscopic radical prostatectomy in a secondary hospital of Greece. Materials and methods: In total 15 cases with localized prostate cancer (3x low risk, 5x intermediate risk and 7x high risk) and a mean age of 70 years (range 58-79) were operated during a 9 month period in our department. All operations were performed by a single laparoscopic surgeon under the supervision of two senior experienced open surgeons and the assistance of an assistant experienced in laparoscopic prostatectomy. Results: No case was converted into open surgery. Mean operating time (OT) dropped gradually from 5.5 hours in the beginning of our experience to up to 2 hours with a mean OT of 3.2 hours including 6 cases where a pelvic lymph node dissection was deemed necessary. Blood loss was minimum in all cases and no transfusion was required. All but 3 cases (80%) were discharged on the first postoperative day and catheter was removed 5 days later under cystographic verification of anastomotic water tightness in the vast majority of cases. Positive surgical margins (PSMs) were present in 5 patients (33%). Immediate continence after catheter removal was evident in 53% of our cases and early continence (continent within 2weeks from catheter removal) in 60%. Out of 10 patients having completed a 3month follow-up, 80% (8/10) were pad free. Both two incontinent patients still use 1 pad per day and include one case with immediate continence which started leaking after salvage radiotherapy initiation. PSA failure (>0.2ng/ dL) at 3 months was evident in 3 (30%) of patients including one patient operated with a PSA of 136ng/dL and two patients without PSMs. All these cases were included in the first 6 operated cases and were scheduled for salvage radiation treatment. At a mean of 56 days post prostatectomy, potency was restored in 3 patients following a penile rehabilitation protocol after surgery while none of the rest of patients requested further treatment for impotency. Conclusions: In the hands of a well-trained surgical group, perioperative morbidity of laparoscopic radical prostatectomy during the initial phases of learning curve is minimum. Early continence outcomes can reach comparative levels with the high volume center literature after the very first cases. Initial oncological outcomes were inferior to the published literature yet they were most likely due to case selection (older patients with adverse pathology) than due to limitations of the operative technique.