Estimated Blood Loss

The average estimated blood loss for the reported series of laparoscopic radical prostatectomy varies widely, as shown in Table 1. The average estimated blood loss in the series from Montsouris was 380 mL for all 550 patients, declining to 290 mL for the last 350 patients (17). The overall transfusion rate was 5.3% in this series, declining to 2.6%

TABLE 1 ■ Summary of Surgical Parameters of Laparoscopic Radial Prostatectomy Experiences Worldwide

Mean

Hospital

Catheter

Overall

No. of

Surgical

OR time

EBL

Transfusion

Conversion

stay

duration

Rectal

complication

Center (Ref.)

patients

Year

approach

(min)

(mL)

rate

rate

(days)

(days)

injury

rate

San Antonio (1)

9

1997

TP

564 (all)

583

Not

0%

7.3

Not

0%

33%

reported

reported

New York (13)

1

1997

EP

345

600

0%

0%

2.5

14

0%

0%

Creteil (18)

134

2001

TP

Last

Not

3%

0%

Last

Last

1.5%

9%

114:240

reported

124:6.1

124:4.8

Berlin (5)

125

2001

TP

265

185

2%

0%

8

12

2.4%

14%

Brussels (7)

50

2001

42 EP

317

First

13%

2%

Last 10:

Last 10:

0%

34%

8 TP

10:1350;

7.5

5.5

last 10:492

Montsouris (17)

550

2002

TP

200

380

5.3%

2.4%

After

Last

1.45%

3.6%

catheter

350:4.2

removal

Boston (10)

70

2002

TP

274

449

10%

1.40%

Not

Not

1.40%

23%

reported

reported

United

100

2002

TP

245

313

3%

1%

4.2

Not

1%

8%

Kingdom (9)

reported

Kobe (37,38)

26

2002

TP

453

850

3.80%

0%

Not

9

3.8%

19%

reported

Leipzig (23)

70

2003

EP

155

350

1.40%

0%

Not

8.2

None

21%

reported

reported

Detroit (11)

250

2003

Robotic

Last 100

Last

Not

Not

Not

4.2

Not

Not

165

100: 150

reported

reported

reported

reported

reported

(with node

dissection),

135 (with-

out node

dissection)

Heilbronn (39)

438

2003

TP

First

First

First

First

First

7

First

10%

219:288;

219:1100;

219:30.1%;

219:3.7%;

219:12;

219:1.4%;

second

second

second

second

second

second

219:218

219:800

219:9.6%

219:0.5%

219:11

219:0%

Milan (12)

80

2003

TP

218

376

53%

0%

4.5

11

None

23%

autologous;

reported

6%

heterologous

MSKCC

250

2004

TP

200

300

5%

0%

1.9

7

0.4%

15%

Abbreviations:TR transperitoneal; ER extraperitoneal; OR, operating room; EBL, estimated blood loss; MSKCC; Memorial Sloan-Kettering Cancer Center.

for the last 350 cases (17). As shown in Table 1, average estimated blood loss at other centers worldwide is similar to that reported from Montsouris; at Memorial Sloan-Kettering Cancer Center the average estimated blood loss is 300 mL and the transfusion rate is 2.5%. The estimated blood loss data from Heilbronn were noticeably higher, with an average estimated blood loss of 1100 mL and a transfusion rate of 30% for their initial 219 patients, and 800 mL with a 9.6% transfusion rate for the last 219 patients (39). The reason for this discrepancy is unclear but could be technical since the Heilbron approach is mainly retrograde. Because lower estimated blood loss represents an advantage of laparoscopic radical prostatectomy over open RP, this parameter requires careful examination.

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