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Laparoscopic Radical Prostatectomy
International training in laparoscopic radical prostatectomy is known to improve operative outcomes and shorten the learning curve associated with the procedure. The following article reports the results of Laparoscopic Radical Prostatectomy as reported by myself in conjunction with my colleague Dr Charles Chabert at the John Flynn Hospital, Gold Coast. Our positive margin rate of 1.1% for disease confined to the prostate compares favourably to international radical prostatecotmy series.
What are the outcomes of radical prostatectomy?
The main outcomes of radical prosatectomy are (1) surgical margins, (2) potency (erection and intercourse) rates, and (3) continence (pad free) rates.
What are positive surgical margins?
When the prostate is removed it is covered in ink to mark where the surgeon has cut. It is then examined under the microscope. If cancer cells touch the ink, then this may indicate that not all of the cancer has been cleared and some has been left behind. This is termed a positive margin. If cancer cells are not touching the ink then this is a negative margin. The first aim of radical prostatectomy, before any other, is to achieve a negative margin. If the cancer has extended outside of the prostate gland into the adjacent tissue then the chance of a positive margin increases. However in cases where the prostate is confined to the prostate gland, then the positive margin rate should be very low as, apart from some rare exceptions, it generally only occurs when the surgeon accidentally cuts into the prostate. In our series we report a positive margin rate of 1.1% for disease confined to the prostate. The following table compares our results to that of the international literature as published in the journal, Urology in 2008.
Positive Surgical Margins of published international series of Open, Laparoscopic and Robotic Radical Prostatectomy:**
(Source: Berryhill et al. Urology 2008, 72:15-23)
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Laparoscopic Prostatectomy |
Robotic Prostatectomy |
Open Prostatectomy |
Gianduzzo and Chabert |
| Positive Margin Rate |
2.3-16.8% |
2.5-22% |
6%-36.7% |
1.1% |
What about erections and urinary control?
In our series, the number of patients recovering their erections (potency) and their urinary conrtol (continence) also compares favourably to the published international literature. We reported a pad free rate at 12 months after the operation of 95% and an intercourse rate of 83% at 12 months in men in whom both nerves have been spared and who had normal erections prior to surgery. Despite this it is important to note that both your waterworks and your erections will take a hit from surgery, irrespective of how, or by whom, your surgery is done.
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