Charles Chabert

Curtain dissection of the lateral prostatic fascia and potency after laparoscopic radical prostatectomy: a veil of mystery

To assess the effect on potency recovery of incorporating a high incision of the lateral prostatic fascia (LPF) or curtain dissection (CD) into our technique of laparoscopic nerve‐sparing radical prostatectomy (LNSRP).

Does intrafascial dissection during nerve-sparing laparoscopic radical prostatectomy compromise cancer control?

To assess whether oncological outcomes are compromised by adopting the curtain dissection (CD) technique (high incision of the peri‐prostatic fascia) during nerve‐preserving radical prostatectomy (RP).

The impact of training on service provision in laparoscopic radical prostatectomy.

To address concerns about the impact of training on patient outcomes during the ‘learning curve’ for laparoscopic radical prostatectomy (LRP), we compare the results of our patients undergoing LRP with and without trainees performing a substantial proportion of the cases.

Blood loss during laparoscopic radical prostatectomy.

PURPOSE To determine the impact of a variety of intraoperative parameters that may affect blood loss during laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS Intraoperative blood loss was calculated for 757 consecutive LRPs performed by the same surgeon (CE) over a 6-year period. The impact of a number of intraoperative factors that may affect blood loss was studied. These factors include the operative approach (transperitoneal or extraperitoneal), neurovascular bundle (NVB) preservation, lateral prostatic fascia preservation, prostate weight, and the impact of the learning curve for the primary surgeon and trainees. Multivariate and univariate analyses were performed to determine the significance of these factors on intraoperative blood loss during LRP. RESULTS Mean (+/-standard deviation) blood loss in the 757 patients was 263 +/- 206 mL. Five (0.7%) patients received transfusions. There was a statistically significant difference between extraperitoneal (256 +/- 207 mL) and transperitoneal (308 +/- 199 mL) LRP in terms of blood loss. Nerve preservation [standard or with preservation of the lateral prostatic fascia (LPF)] resulted in a statistically significantly increase in blood loss (205 mL vs 321 mL, respectively, P < 0.001). It also appears that lateral prostatic fascia dissection, as part of a modified NVB preservation, increases blood loss with statistical significance (295 mL vs 353 mL, respectively P < 0.001). There was no statistically significant increase in blood loss with increasing prostate weight (<30 g, 30-50 g, 50-80 g, >80 g). The learning curve also had no impact on blood loss. Trainees were able to perform LRP without an increase in blood loss when mentored by the primary surgeon (CE). CONCLUSION There was a low requirement for transfusion in this cohort of patients undergoing LRP, and the average blood loss is comparable with the most recently reported minimally invasive prostatectomy series. Blood loss during LRP is mainly affected by nerve preservation, with an average increase of 90 mL for a standard NVB and 150 mL when the lateral prostatic fascia is preserved. It is clear, however, that although NVB preservation may increase blood loss, it does not increase the risk of transfusion for patients or impact on postoperative recovery.

LAPAROSCOPIC RADICAL PROSTATECTOMY IN THE UK: DEFINING AND OVERCOMING THE OBSTACLES

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