Robert Wagenhoffer1, Ivan Lutter2, Matiullah Karwandgar2, Ivan Daniel3, Martin Blažek4, Marek Ondriš2
Objective: Endoscopic extraperitoneal radical prostatectomy (EERPE) is currently one of the standard surgical treatment methods for localized prostate cancer. The objective of this article is to acquaint the Slovak Urology public with the first experience of Slovak urologist using this method in foreign workplace. Material and methods: From January 2008 until May 2009 conducted the author a total of 47 endoscopic extraperitoneal radical prostatectomies. The average age of patients was 67 years (53-76), the average PSA value 7.4 ng/ml (1,4-22), the average prostate volume 32 ml (16-120). 8 patients (17 %) were treated by neoadjuvant hormone therapy. 15 patients (32.6 %) had a history of previous surgery (appendectomy, open and laparoscopic inguinal hernioplasty with mesh placement, cholecystectomy, laparoscopic nephrectomy for renal cell carcinoma). After preparation of the preperitoneal space the technique of EERPE duplicates the steps of open retropubic radical prostatectomy (RRP) with descending technique. Results: The average operating time was 151 minutes (85-245). Pathological stage pT2 had 35 patients, pT3 12 patients. Positive surgical margins were found by 3 patients (8.6 %) in stage pT2 and 4 patients (33 %) in stage pT3. The average blood loss was 120 ml (40-480). There was no conversion and perioperative transfusion. Peroperative complications had two patients (rectal and bladder injury), early postoperative complications also two patients (obstructive anuria, urinary retention). The average length of bladder catheterization was 8.6 days, average length of hospitalization 11 days. 6 months after operation 39 patients (82.9 %) were fully continent. Conclusion: Endoscopic extraperitoneal radical prostatectomy is a combination of minimally invasive laparoscopy with anatomically identical approach like in case of open retropubic radical prostatectomy. In the case that training for learning this method is carried out under the supervision of experienced laparoscopic surgeons, it is possible to achieve oncological and functional results that are fully comparable with the open retropubic radical prostatectomy in a short time.