Laparoscopic radical prostatectomy does not cause significant tissue ischemia

Background: Today, laparoscopic radical prostatectomy is a commonly used operation with patients suffering from prostatic carcinoma. In contrast to the classic open radical prostatectomy, the laparoscopic approach is more patient-friendly, whereas long-term results are similar with both methods. CO2 which is being insufflated during laparoscopic radical prostatectomy at a pressure of 12–14 mm Hg, could cause ischemic disorder of tissue in operating field. Patients and methods: The research group consisted of 44 patients with prostatic carcinoma, coming from the Department of Urology of General Hospital Slovenj Gradec; they were treated with laparoscopic radical prostatectomy, namely the Montsouris technique. The control group however, consisted of 11 patients with prostatic carcinoma from the Department of Urology of the Maribor Teaching Hospital. They were treated with a classic retropubic radical prostatectomy. Besides clinical data and pathological examinations, patients from both groups were examined for activity of GSH-Px, SOD and CAT enzymes in the venous blood before the operation and immediately after it. After the operation we also took a tissue sample of each patient’s bladder neck for immune histochemical and morphometrical examination of open capillary surface. Results: Patients of both groups were clinically comparable. Those, treated with the laparoscopic method had longer operating time than patients treated with the classic approach (219:140 min.), there was also a lower blood loss (343:542), shorter analgesic therapy (3.2:6.5 days), shorter period of urinary catheterisation (5.3:14.7 days). Patients treated laparoscopically, had no statistically notable change in the activity of GSH-Px, SOD and CAT enzymes in the venous blood after the operation in comparison to the activity before the operation. There was also no statistically notable difference in open capillary surface on bladder neck exterior among patients of research and control group. Conclusions: The activity of GSH-Px, SOD and CAT enzymes in the venous blood and the morphometrical analysis of capillary surface on bladder neck exterior show that 12-14 mm Hg pressure of CO2 during the laparoscopic transabdominal radical prostatectomy does not damage microcirculation.