Advantages Of The Laparoscopic Approach

Decreased blood loss and possibly shorter duration of catheterization seem to be the obvious advantages. Blood loss is less partly due to the tamponading effect of the pneumoperitoneum. In most laparoscopic series the estimated blood loss was less than 500 ml compared to an about 1000 ml blood loss after open surgery.10 The urinary continence following surgery appears satisfactory. Erectile function may not completely recover for 1-2 years following surgery. The efficacy of the nerve-sparing technique in the LRP has, therefore, not been adequately studied. Magnification and the better visualization that is provided during laparoscopy can theoretically result in more accurate dissection. This can result in a superior nervesparing technique. The positive margin rate of 13.75-27.9% is comparable to the series by Weider and Soloway,11 who reported 23% positive margins in T1c disease. The positive margin rate during our early experience with LRP was, however, due to violation of the capsule. The bladder neck-sparing technique has been employed with the LRP. Bladder neck-sparing has not been implicated to contribute to increased incidence of positive margins in the vast majority of patients.12 Furthermore, the bladder neck can be widely excised and reconstructed during LRP, should it be required.

The LRP is a minimally invasive option with encouraging early results for the treatment of localized prostate cancer. There has been no randomized or prospective matched study comparing the open and laparoscopic approaches. Furthermore, the LRP series have less than 5 years of follow-up; PSA progression rates over the long term are, therefore, unknown. The LRP should, therefore, be studied prospectively in several large centers before it becomes an accepted option for the treatment of localized prostate cancer.

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