Extra peritoneal laparoscopic radical prostatectomy. Preliminary results

Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication.