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N13 Minimal-invasive surgery – what do we mean by this? Radical perineal prostatectomy (suprasphincteric) RPP and Transperineal Lymphadenectomy (TPL) as minimal-invasive method of the treatment of prostate cancer. Technique of the procedure and own experience

      Introduction and Objectives

      Radical perineal prostatectomy (RPP) was introduced in 1905 by Young. Transperineal Lymphadenectomy (TPL) was introduced by HJ. Keller. Recently there is increasing interest in transperineal approach. The reasons for new interest in this procedure are: better knowledge of pelvic and perineal anatomy, development of new surgical techniques. Radical perineal prostatectomy (suprasphincteric) is characterized by: a very small surgical incision, omitting and preservation of large groups of muscles and blood vessels. RPP provides excellent access to prostate, urethra and neurovascular bundles, very quick postoperative recovery and good cosmetic effect. Operation time is short and performance of vesicourethral anastomosis is very precise, watertight and fast. Procedure is performed successfully even at “difficult” patients (obese, after large abdominal operations, after transurethral prostatic procedures, have large prostatic volume). In addition there is possible to perform lymphadenectomy through perineal incision simultaneously during radical perineal prostatectomy, as is presented in additional movie. The aim of the study is to present results of the radical suprasphincteric perineal prostatectomy and technique of transperineal lymphadenectomy and in addition a schemes, photos and film.

      Material and Methods

      Authors present the course of the operation and early postoperative period of patients with localized prostate cancer who were submitted to radical perineal prostatectomy. Av. age of patients: 62.5 years (48–75 years), initial PSA: av. 16.2 ng/ml (0.69–76.48), Gleason 5 (1+2 – 4+5), T1-T2b. There was no pathological changes in local lymph nodes.

      Results

      Operation parameters: time – av. 110 min, median blood loss – 350 ml, % of the nerve-sparing procedures – 23%, Postoperative period: Patient mobilization and oral nutrition – 1th day after operation. Median total hospital stay – 3.8 days. Removal of the urinary catheter – 7–10th day (in ambulatory). Removal of sutures – 10th day (in ambulatory).

      Conclusions

      Radical Perineal Prostatectomy (suprasphincteric) and Transperitoneal Lymphadenectomy is a valuable treatment method of locally advanced prostate cancer with advantages of low morbidity and short hospitalization. RPP with TPL certainly fulfills requirements of minimal invasive procedure and is characterized by short operating time, good cosmetic results and low percentage of side effects, early patient mobilization and quick start of oral nutrition in comparision to other methods. In opposition to other prostatectomy methods, RPP needs strict cooperation between patient and staff – patient should be profoundly informed about wound hygiene. According to the medical data, proportion of patients with postoperative erectile dysfunction and urinary incontinence is very similar to other methods.