[Finger assisted laparoscopic prostatectomy].

Abstract

OBJECTIVES: Laparoscopic prostatectomy is the treatment of choice for localized prostate cancer. The learning curve for unexperienced teams is dauntingly steep because it is associated with high incidence of complications and such long operation times that the procedure becomes almost unacceptable. Therefore, we needed to seek an alternative for this operation that has been almost unmodified since first description in 1998. METHODS: The patient is placed in lithotomy position and draped with an urological apron similar to the one used for transurethral resection. A beniqué sound is introduced up to the bladder and a 12 mm incision is made in the perineum, through which we slowly introduce the index finger touching the posterior aspect of the prostate. We advance the finger further longitudinally and laterally separating the rectum all the way to the bladder neck and prostatic pedicles on each side. Having freed the prostate, generally the most hazardous manoeuvre, we can then carry out a conventional laparoscopic prostatectomy, safely and quickly because the most difficult step, rectum dissection, has been carried out. RESULTS: Digital separation of the prostate through a perineal incision facilitates the operation a lot and shortens operation times significantly, allowing us to avoid the use of one or two trocars. At this time, we can not present statistical analysis because our limited experience, but there are significant advantages making the procedure easier and operation time shorter. Furthermore, the technique may also be used for laparoscopic cystectomy. CONCLUSIONS: laparoscopic prostatectomy is considered a very difficult procedure, with an unacceptable high incidence of complications, being rectum perforation the most feared. Therefore, laparoscopic prostatectomy assisted by digital manipulation through a small perineal incision appears to be a most welcome development with benefits similar to those brought ten years ago by introduction of hand assisted laparoscopy.