Laser nerve-sparing laparoscopic radical prostatectomy: a feasibility study.

OBJECTIVE: To examine, in a pilot study, the feasibility of laser dissection of the neurovascular bundle (NVB) during nerve-sparing laparoscopic radical prostatectomy (NSLRP). NSLRP demands precise NVB mobilization with minimal collateral tissue trauma and optimal haemostasis. Unlike other methods of delivering energy, lasers have the potential to provide rapid, precise dissection with good haemostasis and minimal adjacent tissue injury. PATIENTS AND METHODS: Five patients were treated with NSLRP; in patient 1 the right NVB was dissected using clips and scissors and the left NVB using the 1064 nm Nd:YAG laser (8 W, continuous-wave mode). In the subsequent four patients, the NVB was dissected bilaterally using the laser. The NVBs were excised for histological analysis. RESULTS: In patient 1, the estimated blood loss for the left (laser) NVB dissection was 20 mL, while the estimated blood loss for the right NVB was 100 mL. The maximum depth of laser necrosis was 327 microm. For the next four patients the mean (range) total operative duration was 214 (166-245) min, the mean NVB dissection time 22 (8-33) min, the mean total blood loss 213 (100-300) mL, the mean estimated NVB blood loss 28 (10-45) mL and the mean depth of tissue injury was 687 microm. There were no complications. There was no recurrence, as assessed by prostate-specific antigen levels, at a mean follow-up of 12 months and all patients were continent. CONCLUSION: Laser NSLRP was relatively straightforward and caused minimal blood loss, allowed a rapid dissection and minimal adjacent tissue injury. It is a promising technique that warrants further evaluation.

The impact of obesity on laparoscopic radical prostatectomy.

OBJECTIVE: To investigate the effect of obesity on the operative variables of patients undergoing laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS: The database entries and case-notes of 532 consecutive patients undergoing LRP from March 2000 to August 2005 were examined retrospectively. Complete data were available on 505 (95%) patients, 108 (21%) of whom were obese (body mass index, BMI, > or = 30 kg/m2). All patients had clinical stage T < or = 3aN0M0 prostate cancer and had their procedure done or supervised by the same surgeon. RESULTS: The patients' prostate-specific antigen level, Gleason score, clinical stage and prostate weight were similar. The mean values for patients deemed not obese and obese were: for operative duration (182 and 197 min, P = 0.01), blood loss (310 and 250 mL, P = 0.66), hospital stay (3.0 and 3.3 nights, P = 1.00), complications (3.5% and 4.6%, P = 0.77), positive margins (15.4% and 20.6%, P = 0.26) and biochemical recurrence (3.8% and 3.7%, P = 1.00) at a mean follow-up of 9.7 and 12.0 months, respectively. CONCLUSION: The operation was significantly longer for obese patients, by a mean of 15 min; all other variables were comparable in the two groups. The results from this study suggest that obese patients can expect a similar outcome to their non-obese counterparts after LRP, when operated on by an experienced surgeon.