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Dr. Ralph Clayman provided support and comments, andDr. Arnon Krongrad assisted with writing.
APPENDIX: SURGICAL INSTRUMENTS FOR LAPAROSCOPICRADICAL PROSTATECTOMY
The 2, 10 mm. trocars are nondisposable with a self-retractable nonmetal sheath and the 3, 5 mm. trocars arenondisposable self-retaining nonmetal.
The 0-degree, 10 mm. laparoscope.The 2, 5 mm. bipolar electrosurgical forceps (1 broad and 1
fine tipped).The 5 mm. cold knife.The 3, 5 mm. atraumatic grasping forceps.The 2, 5 mm. needle holders.The 5 mm. curved electrosurgical scissors.The 1-inch cervical dilator covered with a surgical glove,
which is inserted in the rectum as a rectal bougie to facilitateposterior dissection.
The 24Fr curved metal urethral sound with a small holedrilled in its tip (Benique catheter).
The retrieval/entrapment bag.The 5 mm. suction/irrigation unit.The 2-zero polyglactin sutures on No. 36 needle and 3-zero
polyglactin sutures on a No. 26 needle.The electrocautery unit set on auto cut with a 40 W. max-
imal setting to minimize charring. The other setting is 50 W.for bipolar coagulation.
1. Guillonneau, B. and Vallancien, G.: Laparoscopic radical pros-tatectomy: initial experience and preliminary assessment af-ter 65 operations. Prostate, 39: 71, 1999
2. Schuessler, W. W., Vancaillie, T. G., Reich, H. et al: Transperi-toneal endosurgical lymphadenectomy in patients with local-ized prostate cancer. J Urol, 145: 988, 1991
3. Schuessler, W. W., Kavoussi, L. R., Clayman, R. V. et al: Lapa-roscopic radical prostatectomy: initial case report. J Urol,suppl., 147: 246A, abstract 130, 1992
4. Price, D. T., Chari, R. S., Neighbors, J. D., Jr. et al: Laparoscopicradical prostatectomy in the canine model. J. LaparoendoscSurg, 6: 405, 1996
5. Raboy, A., Ferzli, G. and Albert, P.: Initial experience withextraperitoneal endoscopic radical retropubic prostatectomy.Urology, 50: 849, 1997
6. Raboy, A., Albert, P. and Ferzli, G.: Early experience with ex-traperitoneal endoscopic radical retropubic prostatectomy.Surg Endosc, 12: 1264, 1998
7. Schuessler, W. W., Schulam, P. G., Clayman, R. V. et al: Lapa-
roscopic radical prostatectomy: initial short-term experience.Urology, 50: 854, 1997
8. Guillonneau, B. and Vallancien, G.: Laparoscopic radical pros-tatectomy: the Montsouris experience. J Urol, 163: 418, 2000
Urological oncologists have been relatively complacent about thethreat of new technology in the form of laparoscopic surgery. Many ofus have noted that laparoscopic nephrectomy and nephroureterec-tomy, although feasible, are considerably more time-consuming thanstandard open surgery. Furthermore, our complacency has resultedfrom various rumors of attempts at more difficult procedures, such asradical prostatectomy or cystoprostatectomy, as many institutionswere rumored to have attempted these operations with little success.
During the last 2 years 2 groups in Paris have developed tech-niques for laparoscopic radical prostatectomy by performing dissec-tion in an anatomical fashion, similar to the Walsh procedure andpromising to result in similar outcomes (reference 1 in article).1Details of the Montsouris technique are outlined in this report. Stepsof the procedure are the same as those for standard retropubicprostatectomy except that dissection begins initially posterior withthe seminal vesicles and transection of the vasa. The bladder neck isdissected early in the procedure to combine the Campbell antero-grade and Walsh retrograde dissection prostatectomies but withattention to the details of the Walsh anatomical approach that couldnot be achieved by the standard Campbell prostatectomy technique.
In this outstanding initial experience operative time was approx-imately 3 hours for the most recent 120 cases, average estimatedblood loss was 250 cc, the transfusion rate was less than 1% and theconversion rate was 0%. Patients were discharged home on postop-erative day 3 with no catheters. The technology used by the 2 Pari-sian groups will have to be compared to standard radical retropubicprostatectomy techniques. What will be the margin positive rateswith each approach? What will be the rate of potency return in eachcase? Will equivalent continence rates be achieved and will they beachieved as promptly? Many questions need to be answered but,from the standpoint of a single urological oncologist, my previouslyheld notion that a laparoscopic technique would never supplant opensurgery for radical prostatectomy must be strongly reconsidered. Ipredict increasing use of this approach for the management of organconfined prostate cancer. At least initially the advantages are out-standing.
Carl A. OlssonDepartment of UrologyColumbia University College of PhysiciansNew York, New York
1. Abbou, C., Hoznek, A., Salomon, L. et al.: Laparoscopic radicalprostatectomy. J Urol, suppl., 161: 17, abstract V4, 1999
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