Introduction

Laparoscopic radical prostatectomy represents a "minimally invasive approach" to conventional retropubic radical prostatectomy (1). The technique, however, requires a significant learning curve even for experienced laparoscopic surgeons (1-3). Indeed, it is estimated that the steep part of the learning curve extends over 40 to 50 cases (4). One area of difficulty is mastering laparoscopic suturing techniques in order to perform the urethrovesical anastomosis, which is one of the most demanding steps of the whole procedure. According to Schuessler et al., it represents the part of the procedure requiring the greatest time, taking twice as long as the removal of the prostate (1). However, this technique needs to be standardized at the very beginning of the laparoscopic experience in order to improve its ergonomics and accuracy.

It is trivially obvious to say that urethrovesical anastomosis comes at the end of the radical prostatectomy itself. When the prostate is removed through a laparoscopic approach, the difficulty inherent to this maneuver may be increased by the variable length of the former technical steps, with a direct impact on the surgeon's fatigue and hence on eventual shortcomings compromising the suture's quality. Suturing in the deep pelvis is moreover submitted to anatomical variations able to disturb the suturing technique.

Laparoscopic technique offers optimal light conditions under the pubic symph-ysis and the 10- to 12-fold magnifications permits accurate placement of the sutures which was never approached with open techniques (5). Nevertheless, the reduction of the work space, the distance from the bladder neck to the urethral stump, the weight of a filled bladder in Trendelenburg position, the impaired axial vision in a two-dimensional space, all these usual conditions may lead urologists with limited laparoscopic experience to face severe problems at the end of a demanding procedure. Several technical prerequisites, which are inherent to the whole operative protocol, may yet improve this situation.

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