Improving Urinary Continence after Radical Prostatectomy: Review of Surgical Modifications

Jonathan J. Hwang,Bo Young Kim,Edward M. Uchio 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.10

Purpose: Urinary incontinence remains the most feared long-term complication following radical prostatectomy with potentially devastating psychosocial consequences. In recent years, several surgical techniques have been introduced during radical prostatectomy, both open and laparoscopic/robotic, in the hope of improving urinary continence outcomes. Herein, we review the various surgical modifications that have shown a benefit in minimizing post-prostatectomy urinary incontinence (PPI). Materials and Methods: A comprehensive review of the current urologic literature was conducted to identify surgical techniques that have been correlated with improved continence following radical prostatectomy. Results: Over the years, several surgical modifications have been incorporated into radical prostatectomy in order to minimize the risk of prolonged PPI. Most techniques emphasize the importance of restoring the “normal” pelvic anatomy after removal of the prostate gland. In addition, certain patient factors such as preoperative posterior urethral length and patient age appear to have an independent prognostic value in predicting PPI. Postoperatively, bladder neck contracture remains the most consistent complication leading to PPI. Conclusions: The present findings suggest that the risk of PPI can be minimized, or even eliminated, through careful patient selection and surgical modifications during radical prostatectomy. Purpose: Urinary incontinence remains the most feared long-term complication following radical prostatectomy with potentially devastating psychosocial consequences. In recent years, several surgical techniques have been introduced during radical prostatectomy, both open and laparoscopic/robotic, in the hope of improving urinary continence outcomes. Herein, we review the various surgical modifications that have shown a benefit in minimizing post-prostatectomy urinary incontinence (PPI). Materials and Methods: A comprehensive review of the current urologic literature was conducted to identify surgical techniques that have been correlated with improved continence following radical prostatectomy. Results: Over the years, several surgical modifications have been incorporated into radical prostatectomy in order to minimize the risk of prolonged PPI. Most techniques emphasize the importance of restoring the “normal” pelvic anatomy after removal of the prostate gland. In addition, certain patient factors such as preoperative posterior urethral length and patient age appear to have an independent prognostic value in predicting PPI. Postoperatively, bladder neck contracture remains the most consistent complication leading to PPI. Conclusions: The present findings suggest that the risk of PPI can be minimized, or even eliminated, through careful patient selection and surgical modifications during radical prostatectomy.

저위험군 전립선암에서 근치적 전립선절제술 후 Gleason 점수의 상승의 예측 인자

임택,박승철,정영범,김형진,임정식 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.12

Purpose: The Gleason score is an important predictor of outcome that is used in conjunction with clinical stage and prostate-specific antigen to guide clinical decision making. The prostate biopsy Gleason grade frequently differs from the radical prostatectomy grade. The aim of this study was to determine the risk factors of Gleason upgrading in patients with low-risk prostate cancer after radical prostatectomy. Materials and Methods: We retrospectively analyzed the medical records of 146 patients who underwent radical prostatectomy between 1998 and 2008 in two hospitals of Jeonbuk province in Korea. Pathological Gleason score upgrading was defined as an increase in the Gleason score from ≤6 to ≥7 between the biopsy and radical prostatectomy specimen. Pretreatment clinical and pathological parameters were used to identify predictors of pathological upgrading. Results: Of the total 146 patients, 51 (34.9%) were upgraded postoperatively. Small prostate volume (p=0.008), abnormality on the digital rectal examination, and positive surgical margin (p=0.001) were significantly and positively associated with upgrading after radical prostatectomy. A total of 17 of 65 patients with low-risk prostate cancer (26.2%) were upgraded postoperatively. Small prostate volume (<30 ml) was significantly (p= 0.026) and positively associated with upgrading after radical prostatectomy in patients with low-risk prostate cancer. Conclusions: Overall, 26% of patients with low-risk disease were upgraded postoperatively. Small prostate volume was associated with an increased risk for pathological upgrading after radical prostatectomy. These conclusions should be kept in mind when making treatment decisions for men with low-risk prostate cancer. Purpose: The Gleason score is an important predictor of outcome that is used in conjunction with clinical stage and prostate-specific antigen to guide clinical decision making. The prostate biopsy Gleason grade frequently differs from the radical prostatectomy grade. The aim of this study was to determine the risk factors of Gleason upgrading in patients with low-risk prostate cancer after radical prostatectomy. Materials and Methods: We retrospectively analyzed the medical records of 146 patients who underwent radical prostatectomy between 1998 and 2008 in two hospitals of Jeonbuk province in Korea. Pathological Gleason score upgrading was defined as an increase in the Gleason score from ≤6 to ≥7 between the biopsy and radical prostatectomy specimen. Pretreatment clinical and pathological parameters were used to identify predictors of pathological upgrading. Results: Of the total 146 patients, 51 (34.9%) were upgraded postoperatively. Small prostate volume (p=0.008), abnormality on the digital rectal examination, and positive surgical margin (p=0.001) were significantly and positively associated with upgrading after radical prostatectomy. A total of 17 of 65 patients with low-risk prostate cancer (26.2%) were upgraded postoperatively. Small prostate volume (<30 ml) was significantly (p= 0.026) and positively associated with upgrading after radical prostatectomy in patients with low-risk prostate cancer. Conclusions: Overall, 26% of patients with low-risk disease were upgraded postoperatively. Small prostate volume was associated with an increased risk for pathological upgrading after radical prostatectomy. These conclusions should be kept in mind when making treatment decisions for men with low-risk prostate cancer.

Advantages of Robot-Assisted Laparoscopic Radical Prostatectomy in Obese Patients: Comparison with the Open Procedure

배재준,최석환,권태균,김태환 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.8

Purpose: Obesity has been suggested as a risk factor for worse perioperative outcomes, especially in radical prostatectomy, in several studies. However, the impact of obesity on perioperative outcomes has not yet been well elucidated for robot-assisted laparoscopic radical prostatectomy (RALP). We evaluated whether obesity had an adverse effect on outcomes following RALP compared with retropubic radical prostatectomy (RRP). Materials and Methods: From April 2008 to May 2011, 181 patients underwent radical prostatectomy (RALP, 111; RRP, 70). These patients were subdivided into two groups according to body mass index (BMI): the nonobese group (BMI, 25 kg/m2 or less) and the obese group (BMI, greater than 25 kg/m2). Perioperative outcomes in RALP and RRP were retrospectively compared between the two groups. Results: In RRP, patients in the obese group (n=20) showed greater blood loss and a higher complication rate than did those in the nonobese group (n=50). However, in RALP, no statistically significant differences in perioperative outcomes were observed between the obese (n=37) and the nonobese (n=74) groups. RALP showed less blood loss and a lower complication rate in both the obese and nonobese groups than did RRP. Conclusions: RALP is thought to be a more effective and safer procedure in obese patients compared with traditional open radical prostatectomy. In the management of obese patients with localized prostate cancer, RALP should be considered as a primary choice for treatment. Purpose: Obesity has been suggested as a risk factor for worse perioperative outcomes, especially in radical prostatectomy, in several studies. However, the impact of obesity on perioperative outcomes has not yet been well elucidated for robot-assisted laparoscopic radical prostatectomy (RALP). We evaluated whether obesity had an adverse effect on outcomes following RALP compared with retropubic radical prostatectomy (RRP). Materials and Methods: From April 2008 to May 2011, 181 patients underwent radical prostatectomy (RALP, 111; RRP, 70). These patients were subdivided into two groups according to body mass index (BMI): the nonobese group (BMI, 25 kg/m2 or less) and the obese group (BMI, greater than 25 kg/m2). Perioperative outcomes in RALP and RRP were retrospectively compared between the two groups. Results: In RRP, patients in the obese group (n=20) showed greater blood loss and a higher complication rate than did those in the nonobese group (n=50). However, in RALP, no statistically significant differences in perioperative outcomes were observed between the obese (n=37) and the nonobese (n=74) groups. RALP showed less blood loss and a lower complication rate in both the obese and nonobese groups than did RRP. Conclusions: RALP is thought to be a more effective and safer procedure in obese patients compared with traditional open radical prostatectomy. In the management of obese patients with localized prostate cancer, RALP should be considered as a primary choice for treatment.

용적이 큰 전립선비대증 환자에서 복강경 단순 전립선절제술의 초기 경험

김병환,류동수,오태희 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.5

Purpose: Simple prostatectomy has been a mainstay of therapy for patients with large prostatic adenoma. We describe laparoscopic approach for resection of large prostatic adenoma as an alternative to open simple prostatectomy. Materials and Methods: From July 2006 to May 2007 we performed Laparoscopic simple prostatectomy on 10 patients who were diagnosed with clinically benign prostate hyperplasia(maximal urine flow rate(MFR) ≤10ml/sec, International Prostate Symptom Score(IPSS) ≥12 scores, and prostate weight ≥75g). The steps of our extraperitoneal 5 port technique were longitudinal cystotomy, subcapsular plane development, enucleation of the obstructing prostatic adenoma, insertion of Spongospan into the prostatic fossa, traction of 22Fr balloon catheter and suture repair of cystotomy. Results: We successfully performed the operation in all cases without conversion. The mean patient age is 68.1 years old(60-73). The mean preoperative PSA, prostate volume were 8.8ng/ml(1.8-16.9), 97g(74.1- 120.6). The mean operating time and estimated blood loss were 204min (160-275) and 720ml(300-1,200). The resected mass weight was 45.5g (23-70). There were no major complications. The mean hospitalization stay and drain remove days were 11.3 days(9-14) and 5.6 days(4-8). The mean preoperative MFR, IPSS/quality of life(QoL) and were 2.8ml/sec(0-9.6), 25/5(14-35/4-6) and 270ml(250-310). At 3 months postoperatively, the mean MFR, IPSS/QoL and residual urine volume were 15.6ml/sec(12-23), 10/2.6(5-12/2-4) and 16.75(10-40). Conclusions: Laparoscopic simple prostatectomy could be a useful method for the treatment of large benign prostate hyperplasia. However, more experiences and comparative studies are needed to document the safe and effect compared to open prostatectomy and transurethral resection of prostate. (Korean J Urol 2008;49:418-423) Purpose: Simple prostatectomy has been a mainstay of therapy for patients with large prostatic adenoma. We describe laparoscopic approach for resection of large prostatic adenoma as an alternative to open simple prostatectomy. Materials and Methods: From July 2006 to May 2007 we performed Laparoscopic simple prostatectomy on 10 patients who were diagnosed with clinically benign prostate hyperplasia(maximal urine flow rate(MFR) ≤10ml/sec, International Prostate Symptom Score(IPSS) ≥12 scores, and prostate weight ≥75g). The steps of our extraperitoneal 5 port technique were longitudinal cystotomy, subcapsular plane development, enucleation of the obstructing prostatic adenoma, insertion of Spongospan into the prostatic fossa, traction of 22Fr balloon catheter and suture repair of cystotomy. Results: We successfully performed the operation in all cases without conversion. The mean patient age is 68.1 years old(60-73). The mean preoperative PSA, prostate volume were 8.8ng/ml(1.8-16.9), 97g(74.1- 120.6). The mean operating time and estimated blood loss were 204min (160-275) and 720ml(300-1,200). The resected mass weight was 45.5g (23-70). There were no major complications. The mean hospitalization stay and drain remove days were 11.3 days(9-14) and 5.6 days(4-8). The mean preoperative MFR, IPSS/quality of life(QoL) and were 2.8ml/sec(0-9.6), 25/5(14-35/4-6) and 270ml(250-310). At 3 months postoperatively, the mean MFR, IPSS/QoL and residual urine volume were 15.6ml/sec(12-23), 10/2.6(5-12/2-4) and 16.75(10-40). Conclusions: Laparoscopic simple prostatectomy could be a useful method for the treatment of large benign prostate hyperplasia. However, more experiences and comparative studies are needed to document the safe and effect compared to open prostatectomy and transurethral resection of prostate. (Korean J Urol 2008;49:418-423)

복강경하 근치적 전립선적출술: 초기 150례의 학습곡선

김선욱,홍성후,황태곤 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.10

Purpose: We evaluated the early results and the learning curve of laparoscopic radical prostatectomy in the first 150 patients. Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients with clinically organ-confined prostate cancer underwent laparoscopic radical prostatectomy. For evaluation of the learning curve, morbidity, oncologic, and functional results of the first 50(group 1) and last 50(group 3) procedures were compared. Results: The mean operating time and hospital stay was 289±66 minutes and 6.3±2.9 days, respectively. The median postoperative period of an indwelling Foley catheter was 5 days(range, 3-46 days). The intraoperative complication rate, including transfusion, was 15.3%. A positive surgical margin rate was 37.3%. After a mean follow-up of 33.5 months, a PSA relapse was observed in 39(33.6%) patients. The continence rate was 77.1, 92.2, and 93.7% at 1, 6, and 12 months. Analysis of the learning curve revealed significant differences in the operating time, hospital stay, intraoperative complication rate, and indwelling Foley catheter days, whereas the postoperative complication rate, mean estimated blood loss, positive surgical margin rate, and continence rate 6 months postoperatively showed no influence. Conclusions: Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, the morbidity is low and the oncologic continence result was promising. The learning curve for laparoscopic radical prostatectomy depends not only on the technical skills, but also on the self-perceived definition. It is likely that no complete plateau of the learning curve exists for any article. Standardized expectations and reporting of outcomes could help to better define the true learning curve for laparoscopic radical prostatectomy. Purpose: We evaluated the early results and the learning curve of laparoscopic radical prostatectomy in the first 150 patients. Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients with clinically organ-confined prostate cancer underwent laparoscopic radical prostatectomy. For evaluation of the learning curve, morbidity, oncologic, and functional results of the first 50(group 1) and last 50(group 3) procedures were compared. Results: The mean operating time and hospital stay was 289±66 minutes and 6.3±2.9 days, respectively. The median postoperative period of an indwelling Foley catheter was 5 days(range, 3-46 days). The intraoperative complication rate, including transfusion, was 15.3%. A positive surgical margin rate was 37.3%. After a mean follow-up of 33.5 months, a PSA relapse was observed in 39(33.6%) patients. The continence rate was 77.1, 92.2, and 93.7% at 1, 6, and 12 months. Analysis of the learning curve revealed significant differences in the operating time, hospital stay, intraoperative complication rate, and indwelling Foley catheter days, whereas the postoperative complication rate, mean estimated blood loss, positive surgical margin rate, and continence rate 6 months postoperatively showed no influence. Conclusions: Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, the morbidity is low and the oncologic continence result was promising. The learning curve for laparoscopic radical prostatectomy depends not only on the technical skills, but also on the self-perceived definition. It is likely that no complete plateau of the learning curve exists for any article. Standardized expectations and reporting of outcomes could help to better define the true learning curve for laparoscopic radical prostatectomy.

복강경하 근치적 전립선적출술의 학습 곡선 분석: 후치골 근치적 전립선적출술과의 비교

강민용,구자현,곽철,김현회 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.1

Purpose: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP. Materials and Methods: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy. Results: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p<0.001). However, the estimated mean blood loss(685ml vs. 1,488.0ml, respectively, p<0.05) and the transfusion rate(24.1% vs. 55%, respectively, p<0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups(27.6% vs. 23.6%, respectively, p>0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups. Conclusions: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naïve for prostate cancer surgery, the learning curve is overcome earlier than expected. (Korean J Urol 2008;49:18-23) Purpose: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP. Materials and Methods: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy. Results: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p<0.001). However, the estimated mean blood loss(685ml vs. 1,488.0ml, respectively, p<0.05) and the transfusion rate(24.1% vs. 55%, respectively, p<0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups(27.6% vs. 23.6%, respectively, p>0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups. Conclusions: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naïve for prostate cancer surgery, the learning curve is overcome earlier than expected. (Korean J Urol 2008;49:18-23)

Yonsei Experience in Robotic Urologic Surgery-Application in Various Urological Procedures

박승율,정우주,최영득,정병하,홍성준,나군호 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6

Purpose: The da Vinci(R) robot system has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robot-assisted laparoscopic radical prostatectomy has recently established as one of the standard cares. Based on experience with the robotic prostatectomy, its use is naturally expanding into other urologic surgeries. We examine our practical pattern and application of da Vinci(R) robot system in urologic field. Patients and Methods: Robotic urologic surgery has been performed during a period from July 2005 to August 2008 in a total of 708 cases. Surgery was performed by 7 operators. In our series, radical prostatectomy was performed in 623 cases, partial nephrectomy in 43 cases, radical cystectomy in 11 cases, nephroureterectomy in 18 cases and other surgeries in 15 cases. Results: In the first year, robotic urologic surgery was performed in 43 cases. However, in the second year, it was performed in 164 cases, and it was performed in 407 cases in the third year. In the first year, only prostatectomy was performed. In the second year, partial nephrectomy (2 cases), nephroureterectomy (3 cases) and cystectomy (1 case) were performed. In the third year, other urologic surgeries than prostatectomy were performed in 64 cases. The first robotic surgery was performed with long operative time. For instance, the operative time of prostatectomy, partial nephrectomy, cystectomy and nephroureterectomy was 418, 222, 340 and 320 minutes, respectively. Overall, the mean operative time of prostatectomy, partial nephrectomy, cystectomy and nephrourectectomy was 179, 173, 309, and 206 minutes, respectively. Conclusion: Based on our experience at a single-institution, robot system can be used both safely and efficiently in many areas of urologic surgeries including prostatectomy. Once this system is familiar to surgeons, it will be used in a wide range of urologic surgery.

Predictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy

문성진,박성열,이춘용 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.10

Purpose: The Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy. Materials and Methods: We analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage. Results: Among 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS. Conclusions: If the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed. Purpose: The Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy. Materials and Methods: We analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage. Results: Among 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS. Conclusions: If the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed.

Robot-Assisted Laparoscopic Radical Prostatectomy

나군호 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.2

Purpose: Laparoscopic radical prostatectomy is an alternative to open prostatectomy in the surgical management of prostate cancer. The introduction of surgical robot to assist laparoscopic surgery served as a mechanical device to enhance the laparoscopic skills and improve surgical maneuverability with enhanced visual systems and the multi-axis articulating instruments. This review will introduce the evolution of surgical technique and current status of robotic-assisted laparoscopic prostatectomy. Materials and Methods: A review of literatures is conducted with the homepage of Korean Urologic Association and PubMed, a search tool of the National Library of Medicine and the National Institutes of Health, including the MEDLINE database. Results: After its approval by the United States FDA in 2000, the robotic technology has revolutionized the treatment of surgical management of prostate cancer. Robotic-assisted laparoscopic radical prostatectomy offers benefits of minimally invasive surgery with comparable oncological functional outcomes compared to standard surgical options. Conclusions: This technique is expected to evolve into one of the standard of care in treatment of localized prostate cancer. Purpose: Laparoscopic radical prostatectomy is an alternative to open prostatectomy in the surgical management of prostate cancer. The introduction of surgical robot to assist laparoscopic surgery served as a mechanical device to enhance the laparoscopic skills and improve surgical maneuverability with enhanced visual systems and the multi-axis articulating instruments. This review will introduce the evolution of surgical technique and current status of robotic-assisted laparoscopic prostatectomy. Materials and Methods: A review of literatures is conducted with the homepage of Korean Urologic Association and PubMed, a search tool of the National Library of Medicine and the National Institutes of Health, including the MEDLINE database. Results: After its approval by the United States FDA in 2000, the robotic technology has revolutionized the treatment of surgical management of prostate cancer. Robotic-assisted laparoscopic radical prostatectomy offers benefits of minimally invasive surgery with comparable oncological functional outcomes compared to standard surgical options. Conclusions: This technique is expected to evolve into one of the standard of care in treatment of localized prostate cancer.

복강경 근치적 전립선적출술 150례의 수술 중, 수술 후 초기 합병증

정진우,조혁진,홍성후,김준철,박용현,황태곤 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.9

Purpose: We retrospectively evaluated the intraoperative and perioperative complications of 150 laparoscopic radical prostatectomies that were performed at our institution. Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients underwent laparoscopic radical prostatectomy. The inpatient and outpatient medical records were reviewed. We divided the patients into three groups: the first 50 patients in group I, the middle 50 patients in group II and last 50 patients in group III. The major and minor complications were evaluated in each group. Results: The overall complication rate was 36%. The major complication rate was 7% and the minor complication rate was 29%. The major complication rate was 18% in group I, 2% in group II and 0% in group III. The minor complication rate was 48% in group I, 24% in group II and 16% in group III. The result showed that the complication rate declined with accumulating experience with laparoscopic radical prostatectomy(p<0.05). Conclusions: Although laparoscopic radical prostatectomy is a technically demanding procedure and it has a steep learning curve, the complication rate declined with accumulating experience with laparoscopic radical prostatectomy. The complications were acceptable because they were not severe and they were managed with little difficulty. Purpose: We retrospectively evaluated the intraoperative and perioperative complications of 150 laparoscopic radical prostatectomies that were performed at our institution. Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients underwent laparoscopic radical prostatectomy. The inpatient and outpatient medical records were reviewed. We divided the patients into three groups: the first 50 patients in group I, the middle 50 patients in group II and last 50 patients in group III. The major and minor complications were evaluated in each group. Results: The overall complication rate was 36%. The major complication rate was 7% and the minor complication rate was 29%. The major complication rate was 18% in group I, 2% in group II and 0% in group III. The minor complication rate was 48% in group I, 24% in group II and 16% in group III. The result showed that the complication rate declined with accumulating experience with laparoscopic radical prostatectomy(p<0.05). Conclusions: Although laparoscopic radical prostatectomy is a technically demanding procedure and it has a steep learning curve, the complication rate declined with accumulating experience with laparoscopic radical prostatectomy. The complications were acceptable because they were not severe and they were managed with little difficulty.