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Douglas M Dahl

Publications and source records attributed to Douglas M Dahl.

10 recordsLinked to original sources
PubMed2006

Pathologic outcome of laparoscopic and open radical prostatectomy.

OBJECTIVES: To compare the clinicopathologic data of 286 laparoscopic radical prostatectomies (LRPs) and 714 open radical prostatectomies (RRPs) performed at the Massachusetts General Hospital from 2001 to 2005. METHODS: A total of 1000 radical prostatectomy procedures were analyzed for prostate weight, pathologic stage, Gleason score, surgical margin status, and positive margin location. RESULTS: The mean patient age was 58.6 and 59.1 years for the LRP and RRP groups, respectively. The mean preoperative prostate-specific antigen level was 5.96 and 6.00 ng/mL, respectively. Clinical Stage T1c cancer was seen in 86.4% of the LRP and 90.5% of the RRP patients. Gleason score 7 or less disease was seen on biopsy in 97.5% of the LRP and 96.9% of the RRP patients. The average prostate weight was 46.8 g for LRP and 46.0 g for RRP. In the radical prostatectomy specimens, 94.4% of LRP and 93.3% of RRP patients had Gleason score 7 or less disease and 86.0% of LRP and 81.7% of RRP patients had pathologic Stage pT2 cancer. The rate of positive surgical margins was 15.0% and 17.4% for the LRP and RRP groups, respectively. The positive margins occurred mainly at the peripheral and apical regions in both groups. No significant difference was found in the preoperative variables or final pathologic findings between the two surgical groups. CONCLUSIONS: With similar case selection, LRP and RRP achieve similar pathologic outcomes.

Adult↗
PubMed2006

Laparoscopic radical prostatectomy in a renal allograft recipient.

In the current immunosuppression era, most renal transplant recipients with a functioning allograft are living healthier and longer lives. In men, because of prostate-specific antigen screening, more patients are diagnosed with early prostate cancer and offered curative treatment with radical prostatectomy. Laparoscopic radical prostatectomy is an accepted minimally invasive treatment for a middle-aged man with organ-confined prostate cancer. To our knowledge, laparoscopic prostatectomy has not yet been reported in renal transplant recipients. This is a case report of laparoscopic prostatectomy for biopsy-proven localized prostate cancer in a renal transplant recipient.

Humans↗
PubMed2005

Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases.

OBJECTIVES: To compare the results of 122 transperitoneal laparoscopic radical prostatectomy (TP-LRP) procedures with those of 34 extraperitoneal LRP (EP-LRP) procedures to assess for differences in outcomes and complications. Both TP-LRP and EP-LRP have been touted as effective techniques for performing LRP. METHODS: We retrospectively reviewed 156 LRPs performed by a single surgeon (D.M.D.) at a single institution between October 2001 and June 2003. EP-LRP was introduced in February 2003. RESULTS: The cohorts were similar in terms of mean patient age, height, weight, body mass index, and American Society of Anesthesiologists Physical Status Classification. Of the total cohort, 19 TP-LRP (16%) and 11 EP-LRP (32%) patients had clinical Stage T2; the remainder had clinical Stage T1c. Similarly, 18 TP-LRP (15%) and 9 EP-LRP (26%) patients had a biopsy Gleason grade of 7 or greater. About one third of patients underwent concomitant pelvic lymphadenectomy (all negative), and 15 TP-LRP (12%) and 2 EP-LRP (6%) patients underwent simultaneous inguinal or umbilical herniorrhaphy. Six TP-LRP patients (5%) required significant lysis of bowel adhesions. The patients in both groups had similar mean operative times (197 minutes and 191 minutes for the TP-LRP and EP-LRP group, respectively; P = 0.29). Clinically significant anastomotic leaks were documented in 7 (6%) TP-LRP and 4 (12%) EP-LRP patients (P = 0.22). The two groups had similar mean hemoglobin decreases (3.0 g/dL) and transfusion rates. The mean time of drainage and hospitalization was 0.5 day longer for the TP-LRP cohort. A mean pathologic Gleason grade of 6.3 was noted for each cohort. Twenty-one TP-LRP (17%) and eight EP-LRP (24%) specimens were pathologic Stage T3, and 29 (24%) of the former and 7 (21%) of the latter (P = 0.81) specimens were margin positive. The complication rates were similar (11% and 12% in TP-LRP and EP-LRP groups, respectively; P = 1.0), except for a greater rate of ileus in the TP-LRP cohort (3 patients). CONCLUSIONS: Extraperitoneal LRP appears to offer similar results to TP-LRP. TP-LRP was associated with a slightly greater ileus rate and EP-LRP with a slightly greater anastomotic leak rate (P = 0.22). However, the latter may have been the result of improved detection. Also, it was easier to manage using the EP-LRP approach.

Adenocarcinoma↗
PubMed2005

Laparoscopic radical prostatectomy and body mass index: an assessment of 151 sequential cases.

PURPOSE: Little objective data are available regarding obesity and the performance of laparoscopic radical prostatectomy (LRP). We reviewed our LRP series to determine the effect of body mass index (BMI) on operative time, blood loss, anastomotic leakage, positive margins, length of stay, complications, urinary continence and erectile function. MATERIALS AND METHODS: A single institution retrospective review was performed of 151 sequential LRPs performed by a single surgeon. Patients were separated into those who were nonobese (BMI less than 30), and those with classes I (BMI 30 to 34.9), II (BMI 35 to 39.9) and III (BMI 40 or greater) obesity according to WHO criteria. RESULTS: There were 97 patients in the nonobese and 54 in the obese cohort, including 35, 14 and 5 with classes I to III obesity, respectively. A trend toward greater preoperative prostate specific antigen (p = 0.14), Gleason score (p = 0.06) and American Society of Anesthesiologists classification (p = 0.07) was noted in the obese (BMI 30 or greater) group. The cohorts had similar prostate size (p = 0.11), pathological grade (p = 0.57), pathological stage (p = 0.50), postoperative hemoglobin decrease (p = 0.77) and hospital stay (p = 0.90). The rates of positive margins (p = 1.0), anastomotic leakage (p = 0.49), prostate specific antigen recurrence (p = 1.0) and complication (p = 0.14) were also similar. Early postoperative urinary continence (p = 1.0) and erectile function (p = 0.19) appeared equivalent. Mean operative time +/- SD was greater in obese than in nonobese patients (208 +/- 43 vs 192 +/- 34 minutes, p = 0.02). Mean operative time was longer in patients with classes II and III obesity (220 +/- 47 minutes, p <0.05 and 249 +/- 32, p <0.01, respectively). The class III group had a longer mean operative time than the class I obesity group (198 +/- 34 minutes, p <0.05). Obese patients underwent a greater number of additional procedures at the time of LRP (p = 0.01). CONCLUSIONS: While obesity significantly increased LRP operative time, it did not significantly impact other intraoperative and postoperative surgical parameters. LRP should be offered to obese patients as a feasible and effective treatment option for prostate cancer.

Body Mass Index↗
PubMed2004

Laparoscopic radical prostatectomy: a multi-institutional study of conversion to open surgery.

OBJECTIVES: To perform a multi-institutional review of the incidence and factors contributing to conversion from laparoscopic radical prostatectomy (LRP) to open radical retropubic prostatectomy (RRP) among eight surgeons. METHODS: The medical records from all patients undergoing LRP at seven institutions were reviewed to assess the incidence of open conversion to RRP. The clinical, operative, pathologic, and functional outcomes of patients who required conversion were compiled and analyzed. RESULTS: Of 670 operations, 13 (1.9%) were converted from LRP to RRP. The most common steps at which conversion occurred were the apical dissection (38%) and the posterior seminal vesicle dissection (31%). Failure to progress was the most common cause of conversion, followed by injury to adjacent structures and hypercarbia. Comorbidities associated with conversion were prior pelvic surgery and obesity (body mass index greater than 30). Six of the 13 conversions occurred in the surgeons' first 5 cases. Despite open conversion, patients were continent (no pads) (92%) and potent (44%) with at least 6 months of follow-up. CONCLUSIONS: Open conversion from LRP to RRP is an uncommon event, but is more likely to occur during a surgeon's early experience. Surgeons beginning their experience with LRP are advised to select their patients carefully to minimize the need for conversion to open surgery. Obese patients and those at risk of periprostatic adhesions should initially not be considered for LRP. Despite open conversion, the functional outcomes did not appear to be adversely affected.

Adenocarcinoma↗
PubMed2004

Transperitoneal laparoscopic radical prostatectomy in patients after laparoscopic prosthetic mesh inguinal herniorrhaphy.

Open radical retropubic prostatectomy has been reported to be difficult or impossible in patients who have previously undergone laparoscopic mesh bilateral inguinal hernia repair. We report 2 cases of successful laparoscopic transperitoneal radical prostatectomy performed in patients after prosthetic mesh inguinal herniorrhaphy. The first patient had undergone open bilateral preperitoneal inguinal hernia mesh repair 5 years previously and right laparoscopic transabdominal preperitoneal inguinal hernia mesh repair 7 months previously. The second patient had undergone bilateral transabdominal preperitoneal mesh inguinal herniorrhaphy 1 year previously.

Adenocarcinoma↗
PubMed2004

Ventriculoperitoneal shunt externalization during laparoscopic prostatectomy.

Ventriculoperitoneal shunt placement is the standard treatment for patients with hydrocephalus or increased cerebrospinal fluid pressure. Many patients with ventriculoperitoneal shunts require subsequent surgery. Increasingly, this surgery is performed laparoscopically. We describe externalizing the ventriculoperitoneal shunt outside the abdomen in a patient undergoing extraperitoneal laparoscopic radical prostatectomy.

Adenocarcinoma↗
PubMed2002

Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center.

OBJECTIVES: To report our experience with the first 70 cases of laparoscopic radical prostatectomy. Radical retropubic prostatectomy is an accepted therapy for the management of locally confined prostate cancer. Recently, laparoscopic prostatectomy has been introduced as a minimally invasive alternative to open radical prostatectomy. Several published series from Europe have demonstrated that laparoscopic radical prostatectomy is a safe and feasible approach to the management of localized prostate cancer. METHODS: From May 2000 to May 2001, transperitoneal laparoscopic radical prostatectomy was performed on 70 men, aged 40 to 76 years, who were appropriate candidates for radical retropubic prostatectomy. Patient characteristics, surgical statistics, and pathologic results were prospectively collected. RESULTS: The mean preoperative prostate-specific antigen level was 6.6 ng/mL (range 1.5 to 20.7). The preoperative Gleason sum was 6 in 53 patients (75.7%), 7 in 16 (22.9%), and 8 in 1 patient (1.4%). The mean operating time was 274 minutes (range 165 to 495). The estimated blood loss averaged 449 mL (range 50 to 2750), and 4 patients (5.7%) required blood transfusions. In 1 case, we converted to a standard retropubic approach. Two intraoperative (2.9%) and 14 (20%) overall postoperative complications occurred. Positive surgical margins were reported in 8 specimens (11.4%). At a minimum of 3 months' follow-up, 85% reported use of 0 or 1 pad per day. The operative times, amount of blood loss, and complication rate decreased dramatically with experience. CONCLUSIONS: Laparoscopic radical prostatectomy is a technically demanding procedure that is a feasible option for the surgical treatment of localized prostate cancer. The morbidity of this operation is significantly less than that of radical retropubic prostatectomy. The laparoscopic approach shows significant promise for reducing surgical morbidity and improving the anatomic radical prostatectomy.

Adult↗