Laparoscopic radical prostatectomy: feasibility and benefits of applying pure extraperitoneal laparoscopic approach with preservation of the Retzius’ space - Hood technique
Tóm tắt
Introduction: In prostate cancer treatment, complete removal of the prostate gland through surgery is essential. Despite the primary goal being the complete excision of the tumor, preserving the patient’s quality of life is equally important. The “hood” technique, as described by Tewari et al, is based on the theory of preserving structures within the Retzius’ space, ensuring the conservation of structures after prostatectomy. This aids in controlling early postoperative urinary continence and ensures oncological outcome. This study aims to evaluate the feasibility and assess the initial outcomes of the first 9 cases underwent extra peritoneal laparoscopic radical prostatectomy using the “hood” technique at Binh Dan Hospital.
Method: A case series of nine cases diagnosed with prostate cancer from 01/2022 - 12/2023, clinical stage I to II according to the 8th AJCC/UICC staging system, were evaluated through clinical examination, imaging tests, biochemical tests, and pathological examination. Radical prostatectomy was performed using the “hood” technique via extraperitoneal laparoscopic surgery by one same surgeon. Study variables including cancer stage, pre - and post - operative serum PSA levels, pre - and post - operative TNM staging, Gleason score, intraoperative blood loss, surgical duration, time to catheter removal, time to urinary control, pre - and post-operative erectile function assessed by IIEF-5, and length of stay.
Results: Average age is 68.3 (60 - 79) (median 68.0), average preoperative PSA 21.0 (8.0 - 38.5) ng/mL (median 17.8), average postoperative PSA is 0.05 (0.00 - 0.2) ng/mL (median 0.02), average prostate volume is 41.4 (20.5 - 68.1) mL (median 39.4 mL), average operative time is 235.7 (135 - 360) minutes (median 210 minutes), average blood loss is 450 (50 - 800) mL (median 400 mL), average postoperative days is 5.7 (3 - 8) days (median 6), average day of catheter withdrawal is 6.6 (5 - 14) days (median 5 days). Positive surgical margins: 2/9 cases. All of the patients regained urinary continence within 2 months after urinary catheter removal. No complication during perioperative period.
Conclusion: Hood technique for extraperitoneal laparoscopic prostatectomy is feasible and helps to achieve the early return of urinary continence.
