Laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy versus radical retropubic prostatectomy for prostate cancer

The outcomes of patients with prostate cancer who were candidates for radical prostatectomy were compared with patients who underwent either: (1) radical retropubic prostatectomy (RRP); or (2) laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy (LN-SV-TPP). The staging, surgical, and early postoperative characteristics of 10 consecutive patients treated by RRP were compared with 12 consecutive patients who underwent LN-SV-TPP. Patients who underwent LN-SV-TPP versus RRP had respective median blood loss of 450 versus 1250 ce ( P = 0.001), median anesthesia time of 330 versus 287.5 minutes ( P = 0.05), median surgical time of 237.5 versus 237.5 minutes ( P = 0.6), median units transfused of 0 versus 1 ( P = 0.05), median time to ambulation of 1 versus 2 days ( P = 0.002), median time to oral intake of 1 versus 3.5 days ( P < 0.001), median hospital stay of 3 versus 6 days ( P < 0.001), and median morphine requirements of 44 versus 119 mg (P < 0.001). LN-SV-TPP is less morbid than RRP concerning blood loss, blood transfusions, pain, and postoperative recovery. Compared with LN-SV-TPP, RRP is faster and is particularly indicated for ease of performing a nerve-sparing radical prostatectomy.