Indications Of Laparoscopic Radical Prostatectomy

The indications for the radical laparoscopic prostatectomy are the same as that for the open procedures including treatment of men with localized prostate carcinoma and a life expectancy of 10 years or more.

TABLE 1 ■ History and Technical Modifications of Laparoscopic Radical Prostatectomy

Author

Comment

Schuessler et al. (2)

Guilloeneau and Vallancien (7)

Rassweiler et al. (8)

The first reported case underwent laparoscopic radical prostatectomy Laparoscopic approach to seminal vesicles for its diseases and perineal radical prostatectomy with dissection of these structures Laparoscopic radical prostatectomy is not alternative to open counterpart due to technical difficulty and longer operation time

Feasible to perform extraperitoneal laparoscopic radical prostatectomy with 2 cases

The model of retrovesical dissection of seminal vesicles and vas deferens was first proposed

As a feasible alternative, Transperitoneal laparoscopic radical prostatectomy was promoted as the "Montsouris technique" based on the same principle previously described by Gaston At another center in Paris, the "Creteil" technique committed to a similar technique of transperitoneal laparoscopic radical prostatectomy Described as the "Heilbronn technique", basically consists of an ascending part which is similar to the open counterpart

A standardized technique of extraperitoneal laparoscopic radical prostatectomy shifting from their initial experience with the transperitoneal approach

The goal must be eradication of the disease. There is no rigid age limit for radical prostatectomy and a patient should not be deprived of this procedure based on age alone. Due to the lengthy course of prostate cancer, the age and comorbid conditions of the patient are the most important determinants of the benefits of treatment.

The clinical stage has influence in the outcomes of the radical prostatectomy, together with the Gleason score and the preoperative prostate-specific antigen. The Gleason score is an important prognostic factor, but it cannot be used to determine prognosis or to justify management. Also prostate-specific antigen cannot definitively distinguish the stage of the cancer in an individual patient and should not be used alone as a contraindication to definitive treatment. The final decision must be taken with the consent of the patient after the explanation of likelihood of success and complications of each procedure.

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