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Guy Vallancien

Publications and source records attributed to Guy Vallancien.

At least 19 recordsLinked to original sources
PubMed2003

Principles and advantages of robotics in urologic surgery.

Although the available minimally invasive surgical techniques (ie, laparoscopy) have clear advantages, these procedures continue to cause problems for patients. Surgical tools are limited by set axes of movement, restricting the degree of freedom available to the surgeon. In addition, depth perception is lost with the use of two-dimensional viewing systems. As surgeons view a "virtual" target on a television screen, they are hampered by decreased sensory input and a concurrent loss of dexterity. The development of robotic assistance systems in recent years could be the key to overcoming these difficulties. Using robotic systems, surgeons can experience a more natural and ergonomic surgical "feel." Surgical assistance, dexterity and precision enhancement, systems networking, and image-guided therapy are among the benefits offered by surgical robots. In return, the surgeon gains a shorter learning curve, reduced fatigue, and the opportunity to perform complex procedures that would be difficult using conventional laparoscopy. With the development of image-guided technology, robotic systems will become useful tools for surgical training and simulation. Remote surgery is not a routine procedure, but several teams are working on this and experiencing good results. However, economic concerns are the major drawbacks of these systems; before remote surgery becomes routinely feasible, the clinical benefits must be balanced with high investment and running costs.

Humans↗
PubMed2003

Robotically assisted laparoscopic dismembered pyeloplasty: a chronic porcine study.

OBJECTIVES: To evaluate the feasibility and efficacy of robotically assisted laparoscopic dismembered pyeloplasty in an animal model. We also investigated whether the use of a device that lacks tactile feedback results in tissue damage and subsequent stenosis or leaking of the anastomosis. METHODS: Robotically assisted dismembered pyeloplasty was performed on 10 farm pigs. After 1 month, all pigs were anesthetized again for intravenous urography and to remove the kidney and ureter on the operated side. Histopathologic examination of all specimens was performed. RESULTS: All animals survived the initial procedure without complications. In the first five procedures, the time required for the performance of the anastomosis showed a decreasing trend. In the last five procedures, 30 to 40 minutes were required for the anastomosis. The results of urography showed mild hydronephrosis in 1 case (animal 7). The other animals showed no abnormalities. The histopathologic examination of the specimen showed a large foreign body granuloma in the ureteral wall of animal 7 that caused the before-mentioned obstruction. No significant abnormalities were seen in the other animals. CONCLUSIONS: Robotically assisted laparoscopic dismembered pyeloplasty is a technically feasible procedure with an acceptable morbidity in an animal model. No significant histologic effects were seen of the possibly less-delicate tissue handling by the robotic device. The benefit of this technological progress has not yet been established. Therefore, the use of these techniques has to be thoroughly assessed before their clinical application.

Animals↗
PubMed2003

A 10-year clinical experience with intermittent hormonal therapy for prostate cancer.

OBJECTIVES: To evaluate, over a 10-year period, the feasibility, efficacy, duration of action and adverse effects of intermittent hormonal therapy (IHT) in patients with advanced prostate cancer or biochemical recurrence after radical treatment. MATERIALS AND METHODS: Two hundred and thirty-three patients with prostate cancer have been included in an IHT protocol since 1992. Fifty-five patients had already been treated by radical prostatectomy (group A), 35 patients had received radiotherapy or a treatment with high-intensity focused ultrasound (HIFU) (group B) and 143 patients had not received any previous treatment (group C). Three-monthly injection of LHRH analogue combined with a non-steroidal antiandrogen was administered during the treatment phase ("on" phase). Treatment was stopped ("off" phase) when the PSA level fell below 4 ng/ml, regardless of the duration of the "on" phase. Criteria for resumption of hormonal therapy were PSA >20 ng/ml, PSA progression slope over the previous three months >5 ng/ml per month or recurrence of pain or urinary symptoms. RESULTS: The median follow-up was 34.9 months (range: 13-151) and the median initial PSA was 28 ng/ml (range: 1-433). Five cycles were performed in the patients with the longest follow-up. The mean duration of cycles was gradually decreased from 19.6 months to 11.8 months. The "on/off" ratio was close to 30% regardless of the cycle or patient group. Ten patients (4%) died from their cancer during the study, with a median survival of 42.2 months. Six patients (2.5%) developed painful symptoms during IHT. CONCLUSIONS: IHT ensures medium-term (three years) control of the disease, using a treatment resumption criteria of PSA >20 ng/ml and was not associated with major complications.

Aged↗
PubMed2003

An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy.

OBJECTIVE: To provide a detailed description of the steps involved in a laparoscopic radical prostatectomy in relation to the complex neurovascular anatomy of the male pelvis. AIM AND HYPOTHESIS: We aimed at delineating the neurovascular anatomy to assist in nerve preservation during laparoscopic and robotic radical prostatectomies. METHODS: A team of urologists and an anatomist performed anatomic dissections of 12 male cadavers using a combination of laparoscopic equipment, magnification, and open surgical dissection. Each step involved in laparoscopic prostatectomy was reviewed in relation to the possible impact the step could have on the neurovascular bundles. RESULTS: Dissections were performed systematically to mimic various steps of laparoscopic and robotic prostatectomy. The neurovascular bundles were identified and correlated with video images of actual surgery. This enabled us to construct computer simulations and show the actual nerves on the operative pictures. We specially unraveled the relationship between neurovascular bundles and lateral pelvic and Denonvillier's fascias, both of which enclose and hide these important structures. The course of the bundles was traced from its origin at pelvic plexus to its distal course along the urethra. We also showed the important relationship between pelvic plexus ganglions and seminal vesicles to illustrate the vulnerability of these nerves to thermal, electrical and/or crush injury during seminal vesicle and prostatic pedicle dissections. The importance of additional fine neural plexus along the posterior and antero-lateral surface of the prostate was shown by both gross anatomical and microscopic images. The distal precarious location of the bundles was illustrated by dissections showing anteriorly lifted prostate.These anatomico-operative correlations have not been published for laparoscopic and robotic prostatectomies, which differ significantly in its visual angles, magnifications and sometimes three-dimensional (3D) visualization from its open counter part. CONCLUSION: Laparoscopic and robotic radical prostatectomy provides exposure and visualization of male pelvis not previously appreciated. It is only through a careful reexamination of the anatomy of the male pelvis, in the context of this new procedure, that the improvements in visualization and exposure benefit the surgeon. Our work provides a detailed map relating to operative steps to aid the surgeon in the performance of a nerve sparing robotic and laparoscopic radical prostatectomy.

Fascia↗
PubMed2003

Initial experience in laparoscopic partial nephrectomy for renal tumor with clamping of renal vessels.

PURPOSE: To describe our initial experience with laparoscopic partial nephrectomy (LPN) with clamping of the renal vessels before tumor excision and suturing of the renal parenchyma. PATIENTS AND METHODS: Between July 2001 and April 2002, 19 consecutive patients underwent transperitoneal LPN in our institution, 14 for tumors <4 cm with suspicion of renal-cell cancer and 5 for suspicion of angiomyolipoma at CT with one tumor confirmed histopathologically by percutaneous needle biopsy. We divided these patients into the first 10 cases (Group 1) and the last 9 cases (Group 2). One patient had end-stage renal disease but was not on dialysis; the remaining patients had elective partial nephrectomy. Initially, a ureteral catheter was placed. The partial nephrectomy was performed with clamping of the renal vessels, so that the tumor was excised with cold scissors. Intracorporeal cooling of the kidney was achieved by a ureteral catheter connected to a 4 degrees C solution flowing to the renal pelvis during the whole procedure until the clamps were released. Intracorporeal free-hand suturing was exclusively used to close the collecting system (when opened) and to approximate the renal parenchyma. RESULTS: All procedures were completed laparoscopically. The mean renal warm ischemia time was 28.5+/-7 minutes (range 15-47 minutes). The mean laparoscopic operating time was 125+/-37 minutes (range 90-390 minutes). The mean intraoperative blood loss was 290+/-276 mL (range 25-1200 mL). Two patients required blood transfusion, and four had complications. There was immediate deterioration in renal function (creatinine 1.42+/-0.56 mg/dL), but improvement was seen at 1 month (1.17+/-0.34 mg/dL). There were no statistically significant differences in operative features and outcomes in Groups 1 and 2, but there were improvements in the mean operating time by 30 minutes, the mean intraoperative blood loss by 113 mL without any transfusion, and the mean renal warm ischemia time by 6 minutes. There was only one patient in Group 2 with a complication. The surgical margin was negative for tumor for all patients. Postoperative pathology examination showed renal-cell cancer in 11 patients (pT1), oncocytoma in 3 patients, and angiomyolipoma in 5 patients. The mean tumor grade was 2. The mean tumor size was 25.8+/-11.6 mm with a mean tumor-free margin of 2.6+/-2.4 mm. The median follow-up is 3 months, so oncologic outcome cannot be assessed. CONCLUSION: The technique of LPN can be standardized and should be proposed for small tumors when they are not invading the hilum. Clamping the renal pedicle allows better vision for more accurate tumor excision with a safety margin and hemostatic suturing of the parenchymal defect, resulting in less blood loss and shorter operative time, parameters that improve with experience.

Adenoma, Oxyphilic↗
PubMed2003

Sexual dysfunction in 1,274 European men suffering from lower urinary tract symptoms.

PURPOSE: We determine the prevalence and bothersomeness of erectile and ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of bladder outlet obstruction in real life practice, and analyze predictors of sexual dysfunction in this population. MATERIALS AND METHODS: Sexual function of 1,274 European men with lower urinary tract symptoms was assessed by the DAN-PSSsex questionnaire. The relationship between sexual dysfunction and selected clinical characteristics was analyzed. RESULTS: The proportion of sexually active men decreased from 91% in those 60 years old or younger to 60% in those 70 years old or older. Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were reported by 62%, 63% and 23% of patients, respectively. Erectile dysfunction strongly related with age (40% younger than 60 years, 80% 70 years old or older), lower urinary tract symptom severity (55% mild, 70% severe) and body mass index, hypertension and concomitant treatment with calcium channel antagonists. Reduced ejaculation was significantly related to age (42% younger than 60 years, 82% 70 years old or older), lower urinary tract symptom severity (55% mild, 68% severe) and previous benign prostatic hyperplasia surgery. Pain/discomfort on ejaculation was only related to lower urinary tract symptom severity (7% mild, 31% severe). Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were considered a problem by 96%, 82% and 91% of patients younger than 60 years, respectively. These 3 sexual symptoms were still highly bothersome in patients 70 years old or older. CONCLUSIONS: Erectile dysfunction and reduced ejaculation are highly prevalent in men with lower urinary tract symptoms, and are strongly related to increasing age and lower urinary tract symptom severity. Both these aspects of sexual dysfunction are also highly bothersome, even in advanced age. Sexual function should be carefully assessed in the initial evaluation of patients with lower urinary tract symptoms and in deciding on treatment options, as it may have a negative impact on sex life.

Adult↗
PubMed2003

Allelic losses in localized prostate cancer: association with prognostic factors.

PURPOSE: Loss of heterozygosity (LOH) is the most consistent genetic alteration in prostate cancer (CaP), frequently associated with advanced cancer and metastasis. We performed LOH analysis on 6 chromosomal regions of interest in localized CaP to obtain an overview of allelic losses in organ confined tumors and test the association with the usual prognostic factors. MATERIALS AND METHODS: Tumoral and normal DNA were extracted from 48 radical prostatectomy specimens (all organ confined) with a Gleason score of 5 to 7. Biological and pathological data, such as prostate specific antigen (PSA), Gleason score and perineural invasion (PNI), were correlated with allelic losses at 7q31, 8p22, 12p13, 13q14, 16q23.2 and 18q21. Analysis was done by genotyping using highly informative microsatellites markers. RESULTS: The rate of LOH was 25% for chromosomes 13 and 18, and between 40% and 47% for chromosomes 7, 8, 12 and 16. The mean frequency of overall LOH events was less than 34%. Except for the 12p13 and 16q23.2 loci no significant correlation was found between LOH and PSA or Gleason score. PNI was significantly associated with LOH on 8p22 (p = 0.003) and with a high frequency of LOH events (greater than 34%) (p = 0.02). CONCLUSIONS: The frequency of allelic losses in localized and differentiated CaP is associated with PNI but not with the usual prognostic markers, such as PSA and Gleason score. The relationship between LOH on 8p22 and PNI suggests the presence on this region of a gene involved in epithelium/nerve interaction.

Humans↗
PubMed2003

Initial results of salvage laparoscopic radical prostatectomy after radiation failure.

PURPOSE: We evaluated the feasibility of laparoscopic radical prostatectomy for recurrence after irradiation. MATERIALS AND METHODS: Since 2000, 7 patients with biological failure after irradiation (5 external beam radiation and 2 brachytherapy), and no metastasis on computerized tomography and bone scan underwent a transperitoneal laparoscopic radical prostatectomy according to the Montsouris technique. The left index finger was placed in the rectum to control the prostatorectal dissection. We call this procedure "finger assisted laparoscopy." RESULTS: Average operating time was 190 minutes (range 170 to 210), average blood loss was 387 cc (range 50 to 1,100) and no patient was transfused. Bladder catheter was removed after an average of 13 days because of the slower tissue healing after irradiation. No death or intraoperative complication occurred. There was no conversion to open surgery. Average postoperative stay was 6.4 days. Average followup was 11.2 months. Of the 7 patients 5 are continent (no pad day or night) and 2 have stress incontinence. All patients are impotent. No patient had urethral stenosis or lymphocele. Prostate specific antigen is lower than 0.1 ng/ml in 5 patients and higher in 2. CONCLUSIONS: Laparoscopic salvage radical prostatectomy after irradiation is feasible with no more morbidity than an open procedure. A longer followup is mandatory to evaluate its usefulness.

Aged↗
PubMed2003

Intraoperative frozen section analysis during nerve sparing laparoscopic radical prostatectomy: feasibility study.

PURPOSE: Nerve sparing radical prostatectomy may allow preservation of potency but it can increase positive surgical margins. We used intraoperative frozen section (IFS) analysis to monitor the nerve sparing procedure in laparoscopic prostatectomy. MATERIALS AND METHODS: A total of 100 patients with localized prostatic carcinoma underwent bilateral intrafascial nerve sparing laparoscopic prostatectomy with IFS. A wedge of tissue was cut from base to apex in the region of the neurovascular bundles (NVBs) and analyzed on frozen section. If carcinoma was detected at the inked margin, the corresponding NVB was resected. Definitive margin status was evaluated after permanent section analysis of IFS prostatectomy specimens and eventually NVB specimens. RESULTS: IFS analysis was positive in 24 patients, as confirmed in all by permanent section of the wedges. Three of these patients had positive margins in the prostate specimen at another site. Of the 76 tumors with negative IFSs 1 had positive margins on permanent sections of the wedges and 8 had positive margins on the prostate specimen at another site. IFS led to a decrease in the overall positive margin status from 33% to 12% and from 26.1% to 7.9% in pT2 tumors. Tumor was found on NVB resection in 8 cases (33%). CONCLUSIONS: These results suggest that IFS analysis is a reliable method by which to monitor nerve sparing during laparoscopic prostatectomy. IFS could allow the surgeon to offer a nerve sparing procedure more frequently without compromising cancer control.

Erectile Dysfunction↗
PubMed2002

Impact of human bladder cancer cell architecture on autologous T-lymphocyte activation.

To investigate the influence of tumor cell architecture on T-cell activation, we used an autologous human model based on 2 bladder tumor cell lines as targets for cytotoxic tumor-infiltrating lymphocytes (TILs). These tumor cell lines were grown in vitro as either standard 2-dimensional (2D) monolayers or 3-dimensional (3D) spheroids. T-cell activation was determined by measuring the production of three major cytokines (tumor necrosis factor, granulocyte/macrophage colony-stimulating factor and interferon-gamma), known to be secreted by most activated TILs. Changes in the architecture of target cells from 2D to 3D induced a dramatic decrease in their capacity for stimulating TILs. Interestingly, neither TIL infiltration nor MHC class I, B7.1 costimulatory or lymphocyte function-associated factor-3 adhesion molecule downregulation played a major role in this decrease. These findings demonstrate that tumor architecture has a major impact on T-cell activation and might be implicated in the escape of tumor cells from the immune system.

CD58 Antigens↗
PubMed2002

Cystectomy with prostate sparing for bladder cancer in 100 patients: 10-year experience.

PURPOSE: To minimize the risk of incontinence and impotence without compromising oncological outcome, we performed prostate sparing surgery during radical cystectomy for bladder cancer. MATERIALS AND METHODS: Since 1992, 100 patients with a mean age of 64 years (range 48 to 82) underwent cystectomy for bladder transitional cell carcinoma with prostate sparing based on normal digital rectal examination of the prostate, normal prostate specific antigen (PSA), percent free PSA greater than 15 and normal transrectal ultrasound of the prostate. Prostate biopsies to exclude prostate cancer were performed on patients with an abnormal digital rectal examination, high PSA, percent free PSA less than 15 or hypoechoic lesions on ultrasound. Surgery consisted of transurethral resection of the prostate with analysis of frozen section of the prostatic urethra and transitional prostate and cystectomy with reconstruction by a Z ileal bladder anastomosed to the prostatic capsule after confirmation of the absence of prostate or bladder cancer on frozen sections of the surgical capsule specimens. Patients were followed closely with imaging and laboratory studies every 6 months and annually for 3 years thereafter. RESULTS: Perioperative death occurred in 1 patient due to septicemia, 20 patients (20%) died of cancer and 6 (6%) died of nonrelated cancer causes. Mean followup 38 months (range 2 to 111). Postoperative pathological stage was PT0 in 2 cases, PtaT1 in 22, PT2 in 48, PT 3 in 28 and N+ in 13. The 5-year actuarial global survival according to pathological stage was pTaT1N0 in 96% of cases, pT2N0 in 83%, pT3N0 in 71% and N+ in 54% (p = 0.0001). The 5-year actuarial cancer specific survival was PT0, Ta T1 in 90% of cases, PT2 in 73%, PT3 in 63% and N- in 8%. The cancer specific survival according to pathological grade was 100% for well differentiated tumors (grade I), 76% for moderately differentiated tumors (grade II) and 47% for poorly differentiated tumors (grade III) (p = 0.003). Local recurrence was pTaT1N0 in 1 of 22 cases (4.5%), pT2N0 in 2 of 40 (5%), pT3N0 in 2 of 23 (8.5%) and N+ in 0 of 13 (0%). Prostate cancer was diagnosed in 3 patients (2 errors in the diagnosis and 1 cancer de novo within 5 years of followup). At 1-year followup 86 of 88 patients (97%) are fully continent (no pad) during the day, and 84 (95%) void 1 to 2 times a night to stay dry. Of 61 patients with previously adequate sexual function 50 (82%) maintained potency with retrograde ejaculation secondary to transurethral resection, 6 (10%) have partial potency and 5 (8.1%) are impotent. CONCLUSIONS: Cystectomy with prostate sparing for bladder cancer is feasible and offers promising functional results with no additional oncological risk. Careful selection of patients is mandatory.

Aged↗
PubMed2002

Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes.

PURPOSE: The technique of laparoscopic radical prostatectomy is difficult to master and is associated with a steep learning curve. We hypothesized that a structured approach to establishing a laparoscopic prostatectomy program would diminish complications during the learning process and that robotic technology would be useful in learning the operation. MATERIALS AND METHODS: A structured laparoscopic radical prostatectomy program was introduced at the Vattikuti Urology Institute on October 23, 2000. One of 2 surgeons with a combined experience of more than 500 laparoscopic radical prostatectomies performed or supervised the first prostatectomies, training a third surgeon with extensive "open" surgical skills but no laparoscopic experience. The "trained" surgeon then started performing the operation independently with robotic assistance. The results of this approach were analyzed at the end of 12 months. RESULTS: We performed 48 laparoscopic radical prostatectomies and 50 robot assisted prostatectomies within the 12-month period. The preoperative and intraoperative demographical variables were comparable in both groups as were the operative times, changes in hemoglobin concentrations, durations of hospitalization, positive margin rates and overall complication rates. All measured parameters were comparable to the "best-in-class" values for laparoscopic radical prostatectomy reported in the literature. CONCLUSIONS: A structured approach minimizes complications during the establishment of laparoscopic radical prostatectomy program. Robotic assistance helps skilled "open" surgeons learn the technique of laparoscopic radical prostatectomy.

Humans↗
PubMed2002

Laparoscopic radical prostatectomy. preliminary pathologic evaluation.

OBJECTIVES: Although there is increasing evidence of the interest in the laparoscopic approach for radical prostatectomy, carcinologic data, including surgical margin status, remain to be described. METHODS: We analyzed the oncologic results of laparoscopic prostatectomies performed during 2000. The data were compared with retropubic prostatectomies performed between 1994 and 1997 by the same two senior urologists. After matching for preoperative prostate-specific antigen level, the final analysis included 139 patients in both groups, with similar data for age, biopsy Gleason score, and number of positive biopsies. All specimens were processed with the same method of pathologic evaluation. The results were compared using either the chi-square test or Student t test. RESULTS: The mean prostate weight and rate of positive lymph nodes were similar in both groups. No statistical difference was observed in the distribution of either the radical prostatectomy Gleason score or the pathologic stage between the laparoscopic and retropubic groups. In contrast, the decrease in the rate of positive surgical margins was statistically significant in the laparoscopic approach compared with the retropubic approach (P <0.02), particularly in localized cancers (pT2). No difference was observed in either the length or the distribution of the margin location. The rate of positive apical margins in organ-confined disease was significantly decreased in the laparoscopic group. CONCLUSIONS: These results suggest that laparoscopic prostatectomy performed by trained surgeons does not lead to an increased risk of positive margins compared with the retropubic approach.

Adenocarcinoma↗
PubMed2002

Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience.

OBJECTIVES: Robotic assistance may enhance the precision of anatomic dissection and increase the feasibility of performing laparoscopic radical prostatectomy for most surgeons. We performed a prospective comparison of 30 consecutive patients undergoing conventional radical retropubic prostatectomy (RRP) and 30 initial patients undergoing robot-assisted anatomic prostatectomy (RAP) at our institution. METHODS: The study design was a prospective nonrandomized comparison of anatomic RRP performed using the technique of Walsh and RAP performed with the da Vinci surgical system. We evaluated the baseline patient and tumor characteristics (age, body mass index, serum prostate-specific antigen, Gleason score, and clinical stage), intraoperative parameters (operative time, blood loss, and need for transfusion), postoperative parameters (pain score, hospitalization duration, catheter duration), histopathologic parameters, and complications in the two groups. RESULTS: The preoperative parameters were comparable for both groups of patients. The mean setup time for RAP was 0.95 hours. The mean operating time was 2.3 hours for RRP and 4.8 hours for RAP (P <0.001). One patient required conversion from RAP to RRP because of a lack of progress. The mean blood loss was 970 mL for RRP and 329 mL for RAP (P <0.001). The drop in hemoglobin was greater in the RRP group (4.4 versus 1.2 g in RAP; P <0.05). The mean pain score on postoperative day 1 was 7 in the RRP group and 4 in RAP group (P = 0.05). The mean hospital stay was 56 hours in the RRP group and 36 hours in the RAP group (P value not significant). Sixty-three percent of the RAP and 0% of the RRP groups were discharged within 23 hours (P <0.001). The mean duration of postoperative catheterization was 14 days for the RRP and 11 days for the RAP groups (difference not significant). The pathologic stage, margin status, and prostate-specific antigen values were not different between the two groups. The setup time, operative time, blood loss amount, and catheterization duration were significantly reduced after the first 20 patients. CONCLUSIONS: Currently, RAP is a longer procedure than RRP. However, the blood loss is minimal and patients feel less pain and are discharged earlier from the hospital. In our hands, the margin status and complication rates were comparable for both techniques.

Aged↗
PubMed2002

Laparoscopic radical prostatectomy: assessment after 550 procedures.

PURPOSE: To evaluate our experience in laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between January 1998 and December 2000, 550 consecutive patients eligible for radical prostatectomy, were operated laparoscopically. Data concerning surgery and post-operative course were assessed and recorded. Oncological data were assessed by pathological examination and post-operative PSA level. Functional results were assessed with a self-questionnaire. RESULTS: The mean operating time was 170 min for the last 350 patients. Surgical conversion was necessary in seven patients (1.3%). Mean intra-operative bleeding was 290 ml (range: 50-1500 ml) for the last 350 patients. The overall transfusion rate was 5.27%. Mean bladder catheterization time was 4.2 days and median postoperative stay was 5 days in the last 350 patients. By pathological stage, 4 pT2a specimens (3.3%), 48 pT2b specimens (15%), 21 pT3a specimens (33%), 19 pT3b specimens (47%) were found to have positive surgical margins. For pT2a and pT2b stages, non-biological recurrence probability (PSA<0.1 ng/ml) is, respectively, 92.3% at 36 months, and 86.3% at 31 months. The continence rate (no pad) was 82.3% at 12 months among the 255 first patients. For 47 consecutive selected patients, spontaneous erection rate was 85 and 66% experienced spontaneous intercourse. CONCLUSIONS: Laparoscopic radical prostatectomy is currently feasible, with low perioperative morbidity. Taking into account the postoperative follow-up, oncological results are identical to those obtained with conventional surgery. The functional results are encouraging.

Humans↗
PubMed2002

Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience.

PURPOSE: We prospectively evaluated the morbidity, and minor and major complications of laparoscopic radical prostatectomy performed by a single surgical team. MATERIALS AND METHODS: Between January 28, 1998 and February 28, 2001, 567 patients 42 to 77 years old (mean age plus or minus standard deviation 63.5 +/- 6) with clinically localized prostate cancer underwent laparoscopic radical prostatectomy, including 458 (80.6%), without lymphadenectomy. Mean body mass index was 25.3 +/- 2.9 (range 17.3 to 37.5). American Society of Anesthesiologists score was 1 to 3 in 65%, 27% and 8% of cases, respectively. A total of 12 patients (2.1%) had undergone intra-abdominal surgery below the mesocolon and 40 had undergone urological surgery. Intraoperative and postoperative data were recorded as well as all complications and their severity score within the initial 30 days postoperatively. RESULTS: A total of 105 complications were observed in 97 patients (17.1%), including 21 major (3.7%) and 83 minor (14.6%) complications. Of the patients 21 (3.7%) underwent reoperation for a postoperative complication, including 10 (1.76%) who required an intensive care unit stay. Seven cases (1.2%) were converted to conventional retropubic radical prostatectomy. Mean blood loss was 380 +/- 195 ml. and the overall transfusion rate was 4.9%. In 2 patients (0.3%) deep vein thrombosis was associated with another surgical complication but not with pulmonary embolism. Urological, bowel and hemorrhagic complications represented 66.6%, 16.2% and 7.6% (total 89.4%) of all complications, and 20%, 33.3% and 33.3% of all repeat interventions, respectively. CONCLUSIONS: Laparoscopic radical prostatectomy was performed according to the defined protocol with no complications in 82.9% of patients. The morbidity of this approach compares favorably with that of retropubic surgery. Growing experience and knowledge sharing concerning the prevention and early management of these complications would make possible a further decrease in the morbidity of laparoscopic radical prostatectomy.

Adult↗
PubMed2002

[Localized prostatic cancer: treatment with laparoscopic radical prostatectomy: study with 841 cases].

The authors present their experience in the technique of laparoscopic radical prostatectomy. After 841 operations done from January 1998 to april 2001. They use a trans peritoneal approach with 5 ports of 5 and 10 mm. The prostatectomy is done antegrady and the urethrovesical anastomosis is rebuilt with interrupted 3/0 resorbable sutures. Operating time is 2 hours and 40 minutes (1 h 30 to 6 h 30) Conversion rate is 0.9%, average bleeding is 330 cc and transfusion rate is 2.8%. Bladder catheter is removed between days 3 to 6. hospital stay is 5.8 days. Post-op pain is minimal (2% of antalgics at day 2). There was no death, no embolism, 0.2% of phlebitis, 1.1% of rectal injury. Anstomotic strictures occur in 0.3% of cases. 89.2% of patients are continent after 1 year and 75% of patients under 70 years old who underwent a bilateral nerve sparing procedure were potent at 6 months. Positive margins were observed in 5% of pT2a, 22.5% of pT2b, 22.7% in pT3a and 30% in PT3b. After 2 years 92.5% of patients pT2a and b have a PSA < 0.1 ng/ml. No port seeding or peritoneal invasion by cancer was observed. Laparoscopic radical prostatectomy is a safe surgical procedure which limits the risk of transfusion, of anastomotic stricture, which reduces post op pain and allows a good continence. Potency recovery is promising.

Humans↗