Extraperitoneal laparoscopic radical prostatectomy with 3 trocars: An initial report following the first 36 cases of single-centre

Abstract

Objectives: To evaluate our clinical data on extraperitoneal laparoscopic radical prostatectomy (eLRP) with 3 trocars. Materials and Methods: All consecutive low-risk and intermediate/high risk without lymphadenopathy prostate cancer patients undergoing eLRP with using just 3 trocars by single surgeon (Y.A.) between 2017 and 2018 were included. Clinical data including patients' demographics, intraoperative and postoperative data, complications, and follow-up were recorded and analysed. We are presenting a video of one such case of eLRP with simultaneously right inguinal hernia repair (total extraperitoneal repair) with using 3 trocars. Surgeon (Y.A.) performed modified surgical technique (Heilbronn technique) (1) for eLRP with 3 trocars. Results: There were 36 cases in total with mean follow-up was 8 ± 0.4 months. Mean age was 69 ± 4.1 years old (Table 1). Mean prostate specific antigen was 8.7 ± 2.1 ng/dl (Table 2). Mean operating time was 117 ± 18 min. and 22 cases (10 bilateral and extrafascial) were performed nerve-sparing eLRP. Mean estimated blood loss was 170 ± 80 ml. Mean hospitalization day was 2.7 ± 1 days. Mean catheter removal day was 8 ± 3 days. Surgical margin was negative for all cases with 3 complications (Clavien 2) without major complications. Twenty-seven (75%) patients were continent and 20 (%55.5) patients had erections. Conclusions: The first advantage of this initial series is using just one assistant holding laparoscopic optic with/without hand-eye coordination. Second one is to have similar functional and oncology results with traditional eLRP in the literature with fewer trocars. Indirectly, more cosmesis is third one, as our approach seems more minimally invasive than traditional eLRP.eLRP with simultaneously hernia repair is feasible, safe, and effective with using just 3 trocars in selected cases.