The pubovesical complex-sparing technique on laparoscopic radical prostatectomy.

INTRODUCTION: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. PRESENTATION: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. RESULTS: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. CONCLUSION: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.

Video-assisted left inguinal lymphadenectomy for penile cancer.

BACKGROUND: Penile cancer is a rare disease, most commonly encountered in developing countries. It constitutes 0.4% of cancers in U.S. men and 2.1% in Brazil, with the highest prevalence in the North and Northeast regions. Inguinal lymph node metastasis of penile cancer occurs in 20 to 40% of patients and is an important predictor of cancer-specific mortality. The preferred diagnostic and therapeutic tool to assess the regional lymph nodes is a lymphadenectomy which can, in addition to establishing staging, offers curative potential. MATERIALS AND METHODS: A 44 years old man, previously to underwent a partial penectomy for penile cancer, whose pathology showed a moderately differentiated squamous cell carcinoma with neural and angiolymphatic invasion and negative surgical margins. The pathologic stage of the primary tumor was pT3NxMx. Following a one month course of oral antibiotics, the patient underwent a video-assisted bilateral inguinal lymphadenectomy. In the present video, we highlight the left video-assisted inguinal lymphadenectomy. RESULTS: Seventeen lymph nodes were dissected on the left side, two of them positive for cancer without extracapsular extension. On the right side, fourteen lymph nodes were dissected and one was positive for cancer with extracapsular extension, and the patient underwent based on these pathological findings a pelvic lymphadenectomy, which was similarly conducted using a video-assisted laparoscopic approach. CONCLUSIONS: The conventional open lymphadenectomy has a morbidity that can approach 50% in the current series, despite on the refinements in technique. The video-assisted endoscopy is a recent technique aiming to decrease this inherent complication rate promoting a lymph node resection rate which may be equivalent to the open procedure. This video confirms its feasibility, reduced morbidity, and cancer control efficacy.