Evaluation of the Effectiveness of a Novel Technique for Laparoscopic Radical Prostatectomy

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BACKGROUND: Radical prostatectomy remains the primary surgical treatment for patients with localized prostate cancer. Regardless of the surgical approaches, the risk of complications persists. Therefore, improving the technique of radical prostatectomy remains a pressing issue in uro-oncology.

AIM: To evaluate the effectiveness of a novel technique for laparoscopic radical prostatectomy in patients with localized prostate cancer.

METHODS: An analysis of surgical treatment was performed in 137 patients with localized prostate cancer. Laparoscopic radical prostatectomy was performed in all patients: 80 patients (group 1) underwent the procedure using a modified technique with preservation of the pelvic supportive ligamentous structures, and 57 patients (group 2) — using the standard technique.

RESULTS: Patients in group 1 demonstrated shorter total operative time, reduced intraoperative blood loss, and a decreased duration of urinary bladder drainage via urethral catheter. Earlier recovery of spontaneous urination was associated with a shorter postoperative hospital stay. On average, patients in group 1 had a 1.4-fold shorter hospitalization compared to those in group 2.

CONCLUSION: A new technique for extraperitoneal laparoscopic radical prostatectomy with preservation of the pelvic supportive ligamentous structures has been developed, implemented, and clinically tested in patients with localized prostate cancer. Further research is warranted to assess long-term surgical outcomes.

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作者简介

Denis Volodin

State Research Center — Burnasyan Federal Medical Biophysical Center

编辑信件的主要联系方式.
Email: vmeda@ya.ru
ORCID iD: 0000-0002-9489-6746
SPIN 代码: 3043-3266
俄罗斯联邦, Moscow

Fedor Sevryukov

Privolzhsky Research Medical University

Email: fedor_sevryukov@mail.ru
ORCID iD: 0000-0001-5120-2620
SPIN 代码: 5508-5724

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Nizhny Novgorod

Aleksey Krupin

Privolzhsky Research Medical University

Email: alval.krupin@gmail.com
ORCID iD: 0000-0001-9584-756X
SPIN 代码: 4064-2757

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Nizhny Novgorod

Valentin Krupin

Privolzhsky Research Medical University

Email: vn.krupin@mail.ru
ORCID iD: 0000-0002-4887-4888
SPIN 代码: 8892-7661

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Nizhny Novgorod

参考

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  5. Cornford P, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer-2024 update. Part I: Screening, diagnosis, and local treatment with curative intent. Eur Urol. 2024;86(2):148–163. doi: 10.1016/j.eururo.2024.03.027 EDN: PIUSGN
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  10. Isaev OA, Kyzlasov PS, Sergeev VP, et al. Intra- and early postoperative complications of laparoscopic and robot-assisted radical prostatectomy. Urology Reports (St. Petersburg). 2024;14(3):351–358. doi: 10.17816/uroved635161 EDN: FMVSBC
  11. Kowalewski KF, Tapking C, Hetjens S, et al. Interrupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy: a systematic review and meta-analysis. Eur Urol Focus. 2019;5(6):980–991. doi: 10.1016/j.euf.2018.05.009 EDN: ZZKMUR
  12. Ryabov MA, Byadretdinov ISh, Kotov SV Robot-assisted and laparoscopic radical prostatectomy learning curve. Experimental & Clinical Urology. 2021;14(4):37–43. doi: 10.29188/2222-8543-2021-14-4-37-43 EDN: THLXDC
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2. Fig. 1. The stages of standard laparoscopic radical prostatectomy: a — opening of the intrathecal fascia; b — crossing of the neck of the bladder; c — mobilization of the seminal complex; d — opening of the fascia of Denonvillier; e — crossing of the legs of the prostate; f — crossing and stitching of the dorsal venous complex; g — apical dissection; h — formation of the urethrovesical anastomosis.

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3. Fig. 2. Stages of radical prostatectomy with preservation of the ligamentous apparatus of the small pelvis: a — mobilization of the bladder neck; b — mobilization of the seminal complex; c — opening of the Denonvillier fascia; d — mobilization of the intrathecal fascia of the levator and periprostatic fascia (1 — neurovascular bundle; 2 - periprostatic fascia; 3 — intrathecal fascia; 4 — mesorectum); e — mobilization of the dorsal venous complex (1 — periprostatic fascia; 2 — intratase fascia; 3 — tendon arch of the pelvis); f — apical dissection (1 — apex of the prostate; 2 — pubic articulation of the prostate; 3 — intratase fascia and dorsal venous complex, detrusor apron; 4 — levator); g — intersection of the urethra (1 — urethra; 2 — urethral sphincter; 3 — intratase fascia, dorsal venous complex; 4 — levator); h — urethral-vesical anastomosis (1 — urethra; 2 — neck of the bladder i — anterior reconstruction (1 — urethra; 2 — urethral sphincter; 3 — intratase fascia, dorsal venous complex, detrusor; 4 — detrusor of the bladder).

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