212
Central European Journal of Urology
videosurgery
VIDEOABSTRACT
A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience Video can be found at http://ceju.online/journal/10000/ceju_1236.php
Anup Kumar, Niraj Kumar, Gaurav Kumar, Mikir Patel, Pankaj Gupta Department of Urology & Renal Transplant VMMC & Safdarjung Hospital, New Delhi, India
Citation: Kumar A, Kumar N, Kumar G, Patel M, Gupta P. A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience. Cent European J Urol. 2017; 70: 212. Article history Submitted: Jan. 26, 2017 Accepted: Feb. 20, 2017 Published online: March 22, 2017
Key Words: laparoscopy ‹› prostectomy ‹› prostate cancer Laparoscopic transperitoneal radical prostatectomy (LRP) is technically challenging in obese patients especially in those with a narrow and deep pelvis. We prospectively evaluated the surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients. All consecutive patients with BMI ≥30 Kg/m2 who underwent LRP for localized prostate cancer by a single surgeon between January 2013 and May 2016 at our institution were included. The various clinical data including patients’ demographic profile, peri-operative data, postoperative data and followup were recorded and analyzed. We demonstrate our surgical technique in a video of one such patient. A total of 31 patients were included in the study. The mean BMI was 31.74 Kg/m2. The clinical stage ≤T2 c and ≥T3 a were seen in 88.8% and 11.2% respectively. The D'Amico classification low /intermediate/high risk was seen in 25.2%, 47.4% and 25.4% patients respectively. The mean operating time and mean estimated blood loss were 193.9 min and 190.5 ml respectively. There were no conversions to open surgery. Blood transfusion was required in 2 (6.4%) patients. Right unilateral, left unilateral
Cent European J Urol. 2017; 70: 212
and bilateral nerve sparing was performed in 35.4%, 22.5% and 41.9% patients respectively. The mean hospital stay and mean catheterization time were 4.31 days and 10.8 days respectively. Intraoperative and postoperative complications were seen in 3 (9.6%) and 4 (12.9%) respectively. Positive surgical margins were found in 2 (6.4%) patients. At mean follow up of 15.1 months, the continence rate at 3 months and 12 months were 61.2% and 93.5% respectively. The potency rate at 12 months was 48.38% with biochemical recurrence of 9.6%. Laparoscopic transperitoneal radical prostatectomy in obese patients with clinically localized prostate cancer is technically feasible and safe, with acceptable peri-operative morbidity and excellent functional outcomes. However, this technically challenging procedure should be attempted by surgeons with significant expertise. Conflicts of interest The authors declare no conflicts of interest.
Corresponding author Gaurav Kumar, M.D. [email protected]
doi: 10.5173/ceju.2017.1236
Central European Journal of Urology
videosurgery
VIDEOABSTRACT
A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience Video can be found at http://ceju.online/journal/10000/ceju_1236.php
Anup Kumar, Niraj Kumar, Gaurav Kumar, Mikir Patel, Pankaj Gupta Department of Urology & Renal Transplant VMMC & Safdarjung Hospital, New Delhi, India
Citation: Kumar A, Kumar N, Kumar G, Patel M, Gupta P. A prospective evaluation of surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients: our experience. Cent European J Urol. 2017; 70: 212. Article history Submitted: Jan. 26, 2017 Accepted: Feb. 20, 2017 Published online: March 22, 2017
Key Words: laparoscopy ‹› prostectomy ‹› prostate cancer Laparoscopic transperitoneal radical prostatectomy (LRP) is technically challenging in obese patients especially in those with a narrow and deep pelvis. We prospectively evaluated the surgical outcomes of laparoscopic transperitoneal radical prostatectomy in obese patients. All consecutive patients with BMI ≥30 Kg/m2 who underwent LRP for localized prostate cancer by a single surgeon between January 2013 and May 2016 at our institution were included. The various clinical data including patients’ demographic profile, peri-operative data, postoperative data and followup were recorded and analyzed. We demonstrate our surgical technique in a video of one such patient. A total of 31 patients were included in the study. The mean BMI was 31.74 Kg/m2. The clinical stage ≤T2 c and ≥T3 a were seen in 88.8% and 11.2% respectively. The D'Amico classification low /intermediate/high risk was seen in 25.2%, 47.4% and 25.4% patients respectively. The mean operating time and mean estimated blood loss were 193.9 min and 190.5 ml respectively. There were no conversions to open surgery. Blood transfusion was required in 2 (6.4%) patients. Right unilateral, left unilateral
Cent European J Urol. 2017; 70: 212
and bilateral nerve sparing was performed in 35.4%, 22.5% and 41.9% patients respectively. The mean hospital stay and mean catheterization time were 4.31 days and 10.8 days respectively. Intraoperative and postoperative complications were seen in 3 (9.6%) and 4 (12.9%) respectively. Positive surgical margins were found in 2 (6.4%) patients. At mean follow up of 15.1 months, the continence rate at 3 months and 12 months were 61.2% and 93.5% respectively. The potency rate at 12 months was 48.38% with biochemical recurrence of 9.6%. Laparoscopic transperitoneal radical prostatectomy in obese patients with clinically localized prostate cancer is technically feasible and safe, with acceptable peri-operative morbidity and excellent functional outcomes. However, this technically challenging procedure should be attempted by surgeons with significant expertise. Conflicts of interest The authors declare no conflicts of interest.
Corresponding author Gaurav Kumar, M.D. [email protected]
doi: 10.5173/ceju.2017.1236
