Nerve-Sparing Laparoscopic Radical Prostatectomy at Siriraj Hospital
Sittiporn Srinualnad MD, FRCS (Glasgow)*, Chaiyong Nualyong MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Background : Quality of life after laparoscopic radical prostatectomy has been a discussed issue among
patients. Nerve-sparing radical prostatectomy has been shown to be superior to non-nerve-sparing radical
prostatectomy in terms of potency and continence. The authors have reported their experience of laparoscopic
radical prostatectomy and now developed our technique of nerve-sparing laparoscopic radical prostatectomy.
Objective : To evaluate the feasibility of nerve-sparing laparoscopic radical prostatectomy done at our institute.
Materials and Methods : From December 2005 to August 2006, 28 patients with localized prostate cancer
underwent a nerve-sparing laparoscopic radical prostatectomy. Perioperative data was compared to those
34 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy during the same period.
All patients had PSA of less than 10 and pre-operative Gleason Score of 7 or less. Quality of life including
incontinence and impotency rates was analyzed during three months post-operation.
Results : Patients’ dermographic data, except ages, was similar in the two groups. Operating time was not
different (217 vs. 212 minutes in favor of nerve-sparing). Blood loss was significantly high in nerve-sparing
laparoscopic radical prostatectomy (814 mls vs. 543 mls, p = 0.01). Tumor control was not different within
both groups. Three months after surgery incontinent rates of both groups were not different. 43.75% of
patients with nerve-sparing technique had experienced erection at three months after surgery.
Conclusion : The authors’ early experience has shown that nerve-sparing laparoscopic radical prostatectomy
does not compromise cancer control, although blood loss is higher. This operation should be encouraged in
cancer-localized patients as the patients may gain benefit of better quality of life.
Keywords : Nerve sparing laparoscopic radical prostatectomy, Prostate cancer, Laparoscopy, impotency
