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-Minimally-invasive operation for
prostate cancer-
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The radical prostatectomy has
been modified over the years. With the introduction to the
modern operating room of robots and other tools has come the
latest modification: the laparoscopic radical prostatectomy (LRP).
First described almost 10 years ago, the technique of LRP has
been made standard, reproducible, and efficient in the last 2
years. LRP virtually eliminates the physical and emotional
toll of radical prostate surgery and reduces blood loss,
hospital time, and cost. Published series demonstrate
oncological and functional results comparable to and perhaps
better than what is seen with open radical prostatectomy.
Laparoscopic radical
prostatectomy (LRP) is the latest technical innovation in
prostate cancer care. If measured by effect on treatment
burden, the LRP is arguably the most profound technical
innovation in years. For the surgeon, LRP offers improved
visualization of the anatomy, reduced blood loss, and better
preservation of anatomical structures. For the patient, the
LRP virtually eliminates operative convalescence.
The "delayed fuse" is
a phenomenon of surgical innovation. So it was with
percutaneous nephrostomy, today a common technique that was
first described in 1865 by Thomas Hillier, redescribed in 1955
by Willard Goodwin, then, after a 25-year dormancy, became
widely disseminated. A similar thing happened with the LRP.
LRP was first described in an
abstract in 1992. At that time, only two cases had been
completed and laparoscopic suturing was in its infancy. In
1996, Price et al. reported LRP in the dog and Raboy et al.
completed a clinical case of extraperitoneal LRP. In
1997, Schuessler et al. formally published their experience of
several years before. In 1998, Guillonneau et al.
published a series of 40 robotically-assisted, transperitoneal
LRPs done by two surgeons over an eight-month period at the
Institut Montsouris in Paris. This report was followed by an
update after 65 patients and another update, in February 2000,
after 120 patients. A report of the first 240 LRPs done at the
Institut Montsouris is in press, as is a clinical series
of 43 patients from the Hôpital Henri Mondor. During this
period, other groups began to adopt the LRP and have also now
begun to report their experience at endourological meetings.
Video tapes have been published and post-graduate courses have
been organized. We have recently published a detailed
technical manual.(15)
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LRP benefits from the
introduction into the urological operating room of
surgical robots. Already in use in other disciplines,
robots today perform a range of surgical functions. In
LRP, a voice-controlled AESOP robot is used to hold
the laparoscope. Replacement of a human assistant with
the robot permits a less crowded operating table and
assured the operative team a steady and responsive
view of the field. In its essence, LRP is an amalgam
of well-established open radical prostatectomy
techniques. In its approach to the dorsal venous
complex and neurovascular bundles, the laparoscopic
approach resembles the retrograde Walsh technique.
Unlike previous techniques, the modern LRP, as
standardized at the Institut Montsouris, is done
initially by a transperitoneal approach and is
finished in the retropubic, extraperitoneal space.
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