Resumo

CASTILLO C, OCTAVIO et al. Extraperitoneal laparoscopic radical prostatectomy experience in 310 patients. Rev Chil Cir [online]. 2009, vol.61, n.1, pp. 52-58. ISSN 0718-4026.  doi: 10.4067/S0718-40262009000100010.

Background: Laparoscopic prostatectomy is one of the standard treatments for localized prostate cáncer. Aim: To report our experience with extraperitoneal laparoscopic radical prostatectomy (ELRP). Material and Methods: Prospective recording of 310 ELRP performed between 2001 and 2005. The series was divided chronologically in three groups. Group 1 was formed by the first 100 operated patients and groups 2 and 3 by subsequent series of 100 subjects, to show the learning curve. ELRP was performed using an anterograde technique, placing five trocars. Results: Median age of patients was 62 years. No differences in the clinical data of patients in the different groups were observed. Median prostate specific antigenwas 13.3ng/ml. Onehundred eighty patients (60%)had a Gleason score of 2 to 6: 80 patients (25%) had a score of 7 and 50 patients(15%) had a score of 8 to 10. Two hundred fourteen patients (69%) were in clinical stage Tic, 62 patients (20%) were in stage T2a and 34 patients (11%) were in stage T2b. Surgical times were 185, 139 and 134 min in groups 1,2 and 3 respectively (p < 0.05). Blood transfusions were required in 20, 22 and 3% of patients in groups 1, 2 and 3 respectively. The figures for blood loss were 624, 451 and 268 ce, respectively. Positive surgical margins were observed in 24, 9 and 12% of patients in groups 1, 2 and 3 respectively. Rectal injuries oceurred in 9, 2 and none patient of groups 1, 2 and 3 respectively. Urinary fístula oceurred in 4, 1 and no patient of groups 1, 2 and 3 respectively. Late complications such as bladder neck stricture and incontinence decreased in consecutive groups. Conclusions: ELRP is a safe and effective technique for the treatment of localized prostate cáncer, but it has a learning curve to reduce the incidence of complications.

Palavras-chave : Extraperitoneal laparoscopic prostatectomy; prostate cáncer; learning curve.