Extraperitoneal laparoskopik radikal prostatektomi: İlk 60 vaka deneyimi

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

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