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Laparoscopic Versus Open Radical Prostatectomy: A Comparative Study at a Single Institution

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 5 Linguagem: Inglês

10.1097/01.ju.0000062614.56629.41

1527-3792

Jens Rassweiler, Othmar Seemann, Michael Schulze, Doğu Teber, Martin Hatzinger, Thomas Frede,

Urinary Bladder and Prostate Research

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 May 2003Laparoscopic Versus Open Radical Prostatectomy: A Comparative Study at a Single Institution JENS RASSWEILER, OTHMAR SEEMANN, MICHAEL SCHULZE, DOGU TEBER, MARTIN HATZINGER, and THOMAS FREDE JENS RASSWEILERJENS RASSWEILER , OTHMAR SEEMANNOTHMAR SEEMANN , MICHAEL SCHULZEMICHAEL SCHULZE , DOGU TEBERDOGU TEBER , MARTIN HATZINGERMARTIN HATZINGER , and THOMAS FREDETHOMAS FREDE View All Author Informationhttps://doi.org/10.1097/01.ju.0000062614.56629.41AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There is an ongoing debate about the benefits of laparoscopic radical prostatectomy compared to the open retropubic approach. We compared the last 219 patients treated with open retropubic prostatectomy with 438 patients treated with laparoscopic radical prostatectomy at our institution, focusing on operative data, complications and mid-term outcome. Materials and Methods: From December 1994 to November 1999 a total of 219 patients were treated with open prostatectomy and pelvic lymph node dissection (group 1). From March 1999 to September 2002, 219 patients underwent early (group 2) and 219 underwent late (group 3) laparoscopic radical prostatectomy and pelvic lymph node dissection. The same surgeons performed both operations. All 3 groups were similar with respect to mean patient age, mean prostate specific antigen value, median Gleason score, previous transurethral resection of the prostate and neoadjuvant treatment, although there was a slight stage shift in favor of the 2 laparoscopic groups. Results: Mean operating time was significantly shorter after open surgery (196 minutes) compared to the early laparoscopic group (288) but it did not differ significantly from the late laparoscopic group (218). Mean blood loss (1,550 versus 1,100 versus 800 cc) and transfusion rates (55.7% versus 30.1% versus 9.6%) in groups 1 to 3 favored the laparoscopic groups. The complication rate in groups 1 to 3 was lower for laparoscopy (19.2% versus 13.7% versus 6.4%), but the spectrum differed. The early laparoscopic group had a higher incidence of rectal injuries (1.8% versus 3.2% versus 1.4% in groups 1 to 3, respectively) and urinary leakage (0.5% versus 2.3% versus 0.9%), whereas more lymphoceles (6.9% versus 0% versus 0%), wound infection (2.3% versus 0.5% versus 0%), embolism/pneumonia (2.3% versus 0.5% versus 0.5%) and anastomotic strictures (15.9% versus 6.4% versus 4.1%) occurred after open surgery. The amount of postoperative analgesia was significantly greater after open surgery (50.8 versus 33.8 versus 30.1 mg. in groups 1 to 3, respectively). Median catheter time was longer after open retropubic prostatectomy (12 versus 7 versus 7 days in groups 1 to 3, respectively) but the continence rates were similar in all 3 groups at 12 months (89.9% versus 90.3% versus 91.7%). The rate of positive margins did not differ significantly in groups 1 to 3 (28.2% versus 21.0% versus 23.2%), prostate specific antigen recurrence was equivalent related to the different observation periods. Conclusions: Laparoscopic radical prostatectomy is technically demanding, with an initially longer operative time, higher incidence of rectal injuries and urinary leakage. The overall outcome after 219 cases favors the laparoscopic approach. Consequently, at our institution laparoscopic radical prostatectomy has become the method of choice. 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Volume 169Issue 5May 2003Page: 1689-1693 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordslaparoscopyprostatectomyprostatic neoplasmsMetricsAuthor Information JENS RASSWEILER More articles by this author OTHMAR SEEMANN More articles by this author MICHAEL SCHULZE More articles by this author DOGU TEBER More articles by this author MARTIN HATZINGER More articles by this author THOMAS FREDE More articles by this author Expand All Advertisement PDF downloadLoading ...