Extraperitoneal laparoskopik radikal prostatektomi: İlk 60 vaka deneyimi

Year 2012, Volume: 7 Issue: 1, 26 - 32, 01.01.2012

Fatih Yalçınkaya Osman R Karabacak Fuat Demirel Orhan Yiğitbaşı Muhammed Abdurrahim

Abstract

Amaç: Bu çalışmada kliniğimizde laparoskopik radikal prostatektomi uygulanan ilk 60 hastanın öğrenme eğrisinin başındaki sonuçları retrospektif olarak değerlendirilmiştir.Gereç ve Yöntem: Ocak 2006 ve Haziran 2011 tarihleri arasında lokalize prostat kanseri tanısı alan 60 hastaya ekstraperitoneal desending laparoskopik radikal prostatektomi uygulandı. Hastaların peroperatif ve postoperatif bulguları değerlendirildi.Bulgular: Preoperatif PSA değeri ortalaması 8,8 ng /ml, gleason skoru 6, ortalama operasyon süresi 255 dk ve transfüzyon alan hasta %60 olarak tesbit edildi. Dört hastada açık operasyona dönüldü. Postoperatif erken dönemde 7 hastada komplikasyon görüldü. Hastaların ortalama hastanede kalış süresi 7 gün olarak gerçekleşti. 10 hastada uzun süreli kateterizasyon gerekti. Hastaların operasyon süresi transfüzyon oranı, kateterizasyon süresi, hastalığın onkolojik kontrolü, potens ve kontinans durumu değerlendirildi.Postoperatif dönemde 2 hastada kanama, 5 hastada hematomve 2 hastada skrotal ödem saptandı. 2 olguda anastomoz kaçağı nedeni ile sonda alınma süresi uzadı. Postoperatif anastomoz hattında darlık gelişen 2 hastada transüretral insizyon uygulandı.Bilateral sinir koruyucu cerrahi yapılan 22 hastanın 8 inde potensin geri geldiği izlendi. Postoperatif dönemde hastaların 44 ‘ünün PSA düzeyi < 0,01 olarak ölçüldü.Sonuç: Laparoskopik radikal prostatektomi teknik olarak zordur ve uzunca süren öğrenme eğrisini gerektirir. Laparoskopik radikal prostatektomi sonuçları açık cerrahi ile benzerdir. Henüz yeterli sayıya ulaşmamakla beraber sonuçlar umut verici görünmektedir

Keywords

Prostat kanseri , laparoscopik radikal prostatektomi , laparoscopik extraperitoneal radikal prostatektomi

Laparoscopic extraperitoneal radical prostatectomy: Experience in first 60 patients

Abstract

Objectives: In this study, the learning curve of the first 60 patients on whom laparoscopic radical prostatectomy was performed in our clinic was evaluated retrospectively.Materials and Methods: Between January 2006 and June 2011, a total of 60 patients have been diagnosed with localized prostate cancer underwent laparoscopic extraperitoneal descending radical prostatectomy in our clinic. Preoperative and postoperative results of these patients were evaluated.Results: The mean values of preoperative PSA and Gleason score were 8.8ng/ml and 6 respectively. The mean operation duration was 255 minutes, and the blood transfusion was needed in %60 of the patients. 4 patients were transitied to open surgery.Complications were occured at early postoperative period in 7 patients. The mean hospital stay was 7 days. 10 patients required long-term catheterization. Operation time, transfusion rate, length of catheterization, oncological outcomes, potency and continence status were evaluated. In the postoperative period, hemorrhagie was seen in 2 patients, haematoma 5 and scrotal edema in 2. In 2 cases, catheter duration was extended because of the anastomotic leakage. Transurethral incision was performed in 2 patients who developed postoperative anastomotic stricture. Potency was regained in 8 of the 22 patients who went through bilateral protective neurosurgery. In the postoperative period, PSA level was measured < 0,01 in 44 patients. Conclusion: Laparoscopic radical prostatectomy is technically difficult method and it requires a considerably long learning curve. Our results of the laparoscopic radical prostatectomy were similar to open surgery. Although the number of patients is not enough, the results are promising

Keywords

Prostate cancer , laparoscopic radical prostatectomy , laparoscopic extraperitonel radical prostatectomy

References

• Rassweiler J, Sentker L, Seeman O, Hatzınger M, Rumpelt HJ. Laparoscopıc radical prostatectomy with the Heilb- ronn Technique: An Analysis of the fırst 180 cases. J Urol 2001; 66: 2101-2108.
• Guilloneau B, Cathelineau X, Barret E, et al. Laparoscopic radical prostatectomy: technical and early oncological as- sesment of 40 operations. Eur Urol 1999; 36: 14.
• Bollens R, Vanden Bossche M, Roumeguere T, Damoun A, Ekane S, Hoffmann P, et al. Extraperitoneal laparosco- pic radical prostatectomy. Results after 50 cases. Eur Urol 2001; 40: 65.
• Salomon L, Sèbe P, De la Taille A, Vordos D, Hoznek A, Yiou R, Chopin D, Abbou CC. Open versus laparoscopic radical prostatectomy. Part II. BJU Int. 2004 Jul;94(2):244- 250.
• Schuessler WW, Shulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short term ex- perience. Urology 1997; 50: 854-7.
• Guilloneau B, Cathelineau X, Barret E, Rozet F, Vallencien G. Laparoscopic radical prostatectomy. Preliminary evalu- ation after 28 interventions. Presse Med 1998; 27: 1570-4.
• Laparoscopic extraperitoneal radical prostatectomy: im- pact of the learning curve on perioperative outcomes and margin status. Rodriguez AR, Rachna K, Pow-Sang JM. JSLS. 2010 Jan-Mar;14(1):6-13.
• Guilloneau B and Vallencien G. Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 2000; 163: 418.
• Perioperative complications of laparoscopic radical prosta- tectomy: the Montsouris 3-year experience.Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, Bau- mert H, Vallancien G. J Urol. 2002 Jan;167(1):51-6.
• Salomon L, Sèbe P, De la Taille A, Vordos D, Hoznek A, Yiou R, Chopin D, Abbou CC. Open versus laparoscopic radical prostatectomy: Part I. BJU Int .2004 Jul; 94(2): 238- 43
• Eden CG, Cahıll D, Vass JA, Adams TH, Dauleh MI. Lapa- roscopic radical prostatectomy: the initial UK series. BJU Int. 2002; 90: 876-882.
• Rozet F, Galiano M, Cathelineau X, Barret E, Cathala N, Vallancien G. Extraperitoneal laparoscopic radical prosta- tectomy: a prospective evaluation of 600 cases. J Urol 2005 Sep; 174(3): 908-11.
• Rassweiler J, Schulze M, Teber D, Seemann O, Frede T. La- paroscopıc radical prostatectomy: functional and oncolo- gical outcomes. Curr Opin Urol 2004 Mar; 14(2): 75-82.
• Salomon L, Levrel O, Anastasiadis AG, Saint F, de La Ta- ille A, Cicco A, Vordos D, Hoznek A, Chopin D, Abbou CC. Outcome and complications of radical prostatectomy in patients with PSA
• Secin FP, Savage C, Abbou C, de La Taille A, Salomon L, Rassweiler J, et al. The learning curve for laparoscopic ra- dical prostatectomy: an international multicenter study. J Urol. 2010 Dec; 184(6):2291-6.
• Oncologic outcome after extraperitoneal laparoscopic ra- dical prostatectomy: midterm follow-up of 1115 procedu- res. Paul A, Ploussard G, Nicolaiew N, Xylinas E, Gillion N, de la Taille A, Vordos D, Hoznek A, Yiou R, Abbou CC, Salomon L. Eur Urol. 2010 Feb;57(2):267-72. Epub 2009 Sep 17.
• Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, Melegari S, Palmer KJ, Patel VR. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume cen- ters. J Endourol. 2010 Dec;24(12):2003-15.
• Mariano MB, Tefilli MV, Fonseca GN, Goldraich IH. La- paroscopic radical prostatectomy: 10 years experience. Int Braz J Urol. 2009 Sep-Oct;35(5):565-71
• Stolzenburg JU, Do M, Rabenalt R, Pfeiffer H, Horn L, Truss MC, Jonas U, Dorschner W. Endoscopic extraperito- neal radical prostatectomy: initial experience after 70 pro- cedures. J Urol 2003 Jun; 169(6): 2066-71
• Imamoto T, Goto Y, Utsumi T, Fuse M, Kawamura K, Ka- miya N, Naya Y, Suzuki H, Kondo Y, Ichikawa T. Complica- tions, urinary continence, and oncologic outcomes of lapa- roscopic radical prostatectomy: single-surgeon experience for the first 100 cases. Prostate Cancer. 2011;2011:606505