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Original ArticleOpen Access
Laparoscopic Radical Prostatectomy, Siriraj Resident Experiences: The First Resident Series in Thailand
Ramart P 
,
Leewansangtong S ,
Amornvesukit T ,
Taweemongkongsap T ,
Nualyong C ,
Sujijantararat P
,
Leewansangtong S ,
Amornvesukit T ,
Taweemongkongsap T ,
Nualyong C ,
Sujijantararat P Objective: To evaluate laparoscopic radical prostatectomy (LRP) performed by urological residents trained from SirirajHospital.
Material and Method: Twenty-four laparoscopic radical prostatectomies were performed by 12 urological residents betweenApril 2007 and October 2009 (23 intraperitoneal approaches and one extraperitoneal approach). We used five to six ports.Vesico-urethral anastomosis was sutured by interrupted stitches in two cases and continuous technique in 22 cases. Bilateralpelvic lymphadenectomy were performed in all cases. Demographic data, operative outcome, and pathological outcomeswere analyzed. Pathological reports were used with TNM stage following AJCC 2002. The peri-operative parameters andfollow-up data were studied.
Results: Mean age was 71.3 years and mean serum PSA level was 18.34 ng/ml. Eighty seven percent was clinical localizeddisease. Most Gleason score was 7. Mean operative time was 208.9 minutes and mean blood loss was 295.8 ml. Bloodtransfusion rate was 16.7%. Mean hospital stay was 6.1 days and surgical drain was removed at mean time of 3.9 days. Meancatheter time was 12.5 days. Pathological report shows pT1, pT2, and pT3 at 4.2%, 20.8% and 75.0%, respectively. Nopatients had lymph node metastasis. Positive surgical margin rate was 20.0% and 88.9% in pT2 and pT3, respectively. Tencases received adjuvant hormonal therapy because of pT3. Twenty-three cases were followed at the mean time of 14.8 monthsand mean serum PSA level was 0.03 ng/ml. At the mean time of follow-up, patients had urinary incontinence in 10 cases. Thisgroup had only two cases that used pads, which were more than two pads per day. Two cases had anastomotic stricture thatwas treated by urethral dilatation.
Conclusion: Laparoscopic radical prostatectomy is a difficult operation. Training from an experience surgeon is an importantstep to shorten the learning curve.
Keywords: Prostate cancer, Laparoscopy, Prostatectomy, Resident
Material and Method: Twenty-four laparoscopic radical prostatectomies were performed by 12 urological residents betweenApril 2007 and October 2009 (23 intraperitoneal approaches and one extraperitoneal approach). We used five to six ports.Vesico-urethral anastomosis was sutured by interrupted stitches in two cases and continuous technique in 22 cases. Bilateralpelvic lymphadenectomy were performed in all cases. Demographic data, operative outcome, and pathological outcomeswere analyzed. Pathological reports were used with TNM stage following AJCC 2002. The peri-operative parameters andfollow-up data were studied.
Results: Mean age was 71.3 years and mean serum PSA level was 18.34 ng/ml. Eighty seven percent was clinical localizeddisease. Most Gleason score was 7. Mean operative time was 208.9 minutes and mean blood loss was 295.8 ml. Bloodtransfusion rate was 16.7%. Mean hospital stay was 6.1 days and surgical drain was removed at mean time of 3.9 days. Meancatheter time was 12.5 days. Pathological report shows pT1, pT2, and pT3 at 4.2%, 20.8% and 75.0%, respectively. Nopatients had lymph node metastasis. Positive surgical margin rate was 20.0% and 88.9% in pT2 and pT3, respectively. Tencases received adjuvant hormonal therapy because of pT3. Twenty-three cases were followed at the mean time of 14.8 monthsand mean serum PSA level was 0.03 ng/ml. At the mean time of follow-up, patients had urinary incontinence in 10 cases. Thisgroup had only two cases that used pads, which were more than two pads per day. Two cases had anastomotic stricture thatwas treated by urethral dilatation.
Conclusion: Laparoscopic radical prostatectomy is a difficult operation. Training from an experience surgeon is an importantstep to shorten the learning curve.
Keywords: Prostate cancer, Laparoscopy, Prostatectomy, Resident
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