Laparoscopic Radical Prostatectomy: The Results

  • Evangelos N. Liatsikos
  • Panagiotis Kallidonis
  • Ioannis Georgiopoulos
  • Jens-Uwe Stolzenburg


Laparoscopic radical prostatectomy (LRP) is already a well-established, feasible, and safe alternative to the open approach for more than 10 years. Despite its steep learning curve and the dexterity needed on behalf of the surgeon, LRP evolved greatly over the last decade, taking advantage of the recent advances in laparoscopic and robotic equipment (especially the DaVinci System). During the course of time, the extraperitoneal approach to LRP gained more ground among laparoscopic surgeons, establishing the procedure as a viable, long-lasting, and constantly refined technique. The initial problems of insufficient long-term randomized prospective trials were surpassed over the last years, giving a boost to the technique, which was initially described as a “European virus with global potentials” [1, 2]. The results of LRP, presented in this chapter, are primarily divided in two categories: functional results, which include postoperative continence and potency, and oncological results.


Erectile Function Positive Surgical Margin Laparoscopic Radical Prostatectomy Continence Rate Positive Margin Rate 
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  1. 1.
    Thuroff JW. Laparoscopic radical prostatectomy: feasibility studies or the future standard technique? Curr Opin Urol. 2000;10(5):363–4.PubMedCrossRefGoogle Scholar
  2. 2.
    De La Rosette JJ, et al. Laparoscopic radical prostatectomy: a European virus with global potentials. Arch Esp Urol. 2002;55(6):603–9.Google Scholar
  3. 3.
    Guillonneau B, et al. Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions. Presse Med. 1998;27(31):1570–4.PubMedGoogle Scholar
  4. 4.
    Guillonneau B, et al. Laparoscopic radical prostatectomy: assessment after 240 procedures. Urol Clin North Am. 2001;28(1):189–202.PubMedCrossRefGoogle Scholar
  5. 5.
    Guillonneau B, et al. Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol. 2002;43(2):123–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Abbou CC, et al. Laparoscopic radical prostatectomy: preliminary results. Urology. 2000;55(5):630–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Jacob F, et al. Laparoscopic radical prostatectomy: preliminary results. Eur Urol. 2000;37(5):615–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Nadu A, et al. Early removal of the catheter after laparoscopic radical prostatectomy. J Urol. 2001;166(5):1662–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Olsson LE, et al. Prospective patient-reported continence after laparoscopic radical prostatectomy. Urology. 2001;58(4):570–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Link RE, et al. Health related quality of life before and after laparoscopic radical prostatectomy. J Urol. 2005;173(1):175–9; discussion 179.PubMedCrossRefGoogle Scholar
  11. 11.
    Milhoua PM, et al. Issue of prostate gland size, laparoscopic radical prostatectomy, and continence revisited. Urology. 2008;71(3):417–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Novara G, et al. Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol. 2010;184(3):1028–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Rassweiler J, et al. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol. 2001;166(6):2101–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Rassweiler J, et al. Heilbronn laparoscopic radical prostatectomy. Technique and results after 100 cases. Eur Urol. 2001;40(1):54–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Rassweiler J, et al. Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol. 2004;14(2):75–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Goeman L, et al. Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol. 2006;24(3):281–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Menard J, et al. Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology. 2008;72(3):593–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Salomon L, et al. Urinary continence and erectile function: a prospective evaluation of functional results after radical laparoscopic prostatectomy. Eur Urol. 2002;42(4):338–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Stolzenburg JU, et al. Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 2000 cases.J Endourol. 2008;22(10):2319–25.PubMedCrossRefGoogle Scholar
  20. 20.
    Stolzenburg JU, et al. Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Eur Urol. 2008;53(5):931–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Stolzenburg JU, et al. Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases. J Endourol. 2009;23(9):1467–72.PubMedCrossRefGoogle Scholar
  22. 22.
    Rozet F, et al. Extraperitoneal laparoscopic radical prostatectomy: a prospective evaluation of 600 cases. J Urol. 2005;174(3):908–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Stolzenburg JU, Liatsikos EN, Rabenalt R, Do M, et al. Nerve sparing endoscopic extraperitoneal radical prostatectomy – effect of puboprostatic ligament preservation on early continence and positive surgical margins. Eur Urol. 2006;49:103–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Patel VR, Coehlo RF, Palmer KJ, Rocco B, et al. Periurethral suspension stitch during robotic-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol. 2009;56:472–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Stolzenburg JU, Kallidonis P, Hicks J, Do M, Dietel A, et al. Effect of bladder neck preservation during endoscopic extraperitoneal radical prostatectomy on urinary continence. Urol Int. 2010;85(2):135–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Levinson AW, et al. Association of surgeon subjective characterization of nerve sparing quality with potency following laparoscopic radical prostatectomy. J Urol. 2008;179(4):1510–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Rassweiler J, et al. Anatomic nerve-sparing laparoscopic radical prostatectomy: comparison of retrograde and antegrade techniques. Urology. 2006;68(3):587–91; discussion 591–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Guillonneau B. Neurological and vascular preservation during laparoscopic radical prostatectomy. Prog Urol. 2009;19 Suppl 4:S180–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Matin SF. Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy. Urology. 2006;67(5):1012–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Tewari A, et al. An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003;43(5):444–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Chabert CC, et al. Curtain dissection of the lateral prostatic fascia and potency after laparoscopic radical prostatectomy: a veil of mystery. BJU Int. 2008;101(10):1285–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Kaiho Y, Nakagawa H, Saito H, Ito A, Ishidoya S, et al. Nerves at the ventral prostatic capsule contribute to erectile function: initial electrophysiological assessment in humans. Eur Urol. 2009;55:148–55.PubMedCrossRefGoogle Scholar
  33. 33.
    Guillonneau B, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute. J Urol. 2003;169(4):1261–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Anastasiadis AG, et al. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology. 2003;62(2):292–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Roumeguere T, et al. Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol. 2003;20(6):360–6.PubMedGoogle Scholar
  36. 36.
    Mariano MB, et al. Laparoscopic radical prostatectomy: 10 years experience. Int Braz J Urol. 2009;35(5):565–71; discussion 571–2.PubMedCrossRefGoogle Scholar
  37. 37.
    Murphy DG, et al. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009;55(6):1358–66.PubMedCrossRefGoogle Scholar
  38. 38.
    Stolzenburg JU, Kallidonis P, Do M, Dietel A, et al. A comparison of outcomes for interfascial and intrafascial nerve-sparing radical prostatectomy. Urology. 2010;76(3):743–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Liatsikos E, Assimakopoulos K, Stolzenburg J-U. Quality of life after radical prostatectomy. Urol Int. 2008;80(3):226–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Van der Poel HG, de Blok W. Role of extent of fascia preservation and erectile function after robot-assisted laparoscopic prostatectomy. Urology. 2009;73(4):816–21.PubMedCrossRefGoogle Scholar
  41. 41.
    Rassweiler J, et al. Laparoscopic radical prostatectomy with the Heilbronn technique: oncological results in the first 500 patients. J Urol. 2005;173(3):761–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Frota R, et al. The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy. BJU Int. 2008;101(5):589–93.PubMedCrossRefGoogle Scholar
  43. 43.
    Chang CM, et al. The impact of prostate size in laparoscopic radical prostatectomy. Eur Urol. 2005;48(2):285–90.PubMedCrossRefGoogle Scholar
  44. 44.
    Secin FP, et al. Positive surgical margins and accessory pudendal artery preservation during laparoscopic radical prostatectomy. Eur Urol. 2005;48(5):786–92; discussion 793.PubMedCrossRefGoogle Scholar
  45. 45.
    Zorn KC, et al. Long-term functional and oncological outcomes of patients undergoing sural nerve interposition grafting during robot-assisted laparoscopic radical prostatectomy. J Endourol. 2008;22(5):1005–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Frede T, et al. Laparoscopic radical prostatectomy – impact of training and supervision. Minim Invasive Ther Allied Technol. 2005;14(2):104–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Martorana G, et al. Laparoscopic radical prostatectomy: oncological evaluation in the early phase of the learning curve comparing to retropubic approach. Arch Ital Urol Androl. 2004;76(1):1–5.PubMedGoogle Scholar
  48. 48.
    Salomon L, et al. Outcome and complications of radical prostatectomy in patients with PSA <10 ng/ml: comparison between the retropubic, perineal and laparoscopic approach. Prostate Cancer Prostatic Dis. 2002;5(4):285–90.PubMedCrossRefGoogle Scholar
  49. 49.
    Ruiz L, et al. Comparison of early oncologic results of laparoscopic radical prostatectomy by extraperitoneal versus transperitoneal approach. Eur Urol. 2004;46(1):50–4; discussion 54–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Erdogru T, et al. Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. Eur Urol. 2004;46(3):312–9; discussion 320.PubMedCrossRefGoogle Scholar
  51. 51.
    Pavlovich CP, et al. 3-year actuarial biochemical recurrence-free survival following laparoscopic radical prostatectomy: experience from a tertiary referral center in the United States. J Urol. 2008;179(3):917–21; discussion 921–2.PubMedCrossRefGoogle Scholar
  52. 52.
    Sharma NL, Papadopoulos A, Lee D, McLoughlin J, et al. First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. BJU Int. 2010. doi: 10.1111/j.1464-410X.2010.09941.x.
  53. 53.
    Ficcara V, Novara G, Artibani W, Cestari A, et al. Retropubic, laparoscopic and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55:1037–63.CrossRefGoogle Scholar
  54. 54.
    Guillonneau B, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol. 2002;167(1):51–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Stolzenburg JU, et al. Categorisation of complications of endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. World J Urol. 2006;24(1):88–93.PubMedCrossRefGoogle Scholar
  56. 56.
    Liatsikos E, et al. Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy. World J Urol. 2008;26(6):571–80.PubMedCrossRefGoogle Scholar
  57. 57.
    Tozawa K, et al. Evaluation of operative complications related to laparoscopic radical prostatectomy. Int J Urol. 2008;15(3):222–5.PubMedCrossRefGoogle Scholar
  58. 58.
    Lasser MS, et al. An unbiased prospective report of perioperative complications of robot-assisted laparoscopic radical prostatectomy. Urology. 2010;75(5):1083–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Rabbani F, et al. Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol. 2010;57(3):371–86.PubMedCrossRefGoogle Scholar
  60. 60.
    Lebeau T, et al. Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy. Surg Endosc. 2011;25:536–42. Epub 2010 July 8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Evangelos N. Liatsikos
    • 1
  • Panagiotis Kallidonis
    • 1
  • Ioannis Georgiopoulos
    • 1
  • Jens-Uwe Stolzenburg
    • 2
  1. 1.Department of UrologyUniversity of PatrasPatrasGreece
  2. 2.Department of UrologyUniversity of LeipzigLeipzigGermany

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