Objective: This study is aimed to report and evaluate the experience and learning curve of extraperitoneal Laparoscopic Radical Prostatectomy (LRP) performed in Cipto Mangunkusumo General Hospital Jakarta. Material & method: We collected all data of patients that had been performed extraperitoneal LRP from June 2013 until February 2016, retrospectively. We divided those data into 3 groups with equal number in each group. We compared the preoperative (age, prostate volume, PSA level and prostate cancer staging), intraoperative (surgery time, total blood loss, conversion to open surgery and other organ injury), and postoperative (postoperative length of stay) variables between those 3 groups using ANOVA and Kruskal-Wallis test. Results: We performed 15 extraperitoneal LRP from June 2013 until February 2016 with patient’s mean age was 64.40 (SD ± 5.30) years old and mean prostate volume was 42.39 (SD ± 29.21). In this study, we found significant differences in surgery time, total blood loss, and postoperative length of stay (LOS) in all group with decrease on each intraoperative and postoperative variables. We also found no conversion to open surgery or other organ injury in all patients. Conclusion: The increase of surgeon’s experience and the number of surgery, and the consistency undergo the procedure of LRP demonstrate a decrease in surgery time, intraoperative blood loss and LOS in LRP patients.
Laparoscopic radical prostatectomy, learning curve, prostate cancer
Mottet N. Guidelines on prostate cancer. European Association of Urology; 2015.
Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations. Prostate. 1983; 4: 473–85.
Schuessler WW, Kavoussi LR, Clayman RV, Vancaille T. Laparoscopic radical prostatectomy: Initial case report. J Urol. 1992; 147: 246A.
Johan M, Mochtar CA, Umbas R. Preliminary report: Laparoscopic radical prostatectomy in Jakarta. Indonesian Journal of Urology. 2012; 19(2): 94–5.
Saito FJA, Dall’Oglio MF, Ebaid GX, Bruschini H, Chade DC, Srougi M. Learning curve for radical retropubic prostatectomy. Int Braz J Urol. 2011; 37(1): 87–78.
Schuessler WW, Schulam PG, Clayman V, Kavoussi LR. Laparoscopic radical prostatectomy: Initial short-term experience. Urology. 1997; 50(6): 854–7.
Mitre AI, Chammas Jr MF, Rocha Jr JEA, Duarte RJ, Ebaid GX, Rocha FT. Laparoscopic radical prostatectomy: The learning curve of a low volume surgeon. Scientific World Journal; 2013. Article ID 974276, 5 pages.
Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: A structured debate. J Urol. 2000; 163: 1802–7.
Hoznek A, Menard Y, Salomon L, Abbou CC. Update on laparoscopic and robotic radical prostatectomy. Curr Opin Urol. 2005; 15: 173-80.
Levinson AW, SuL M. Laparoscopic radical prostatectomy: Current techniques. Curr Opin Urol. 2007; 17(2): 98–103.
Rassweiler J, Hruza M, Teber D, Su LM. Laparoscopic and robotic assisted radical prostatectomy – critical analysis of the results. Eur Urol. 2006; 49: 612–24.
Vallencien G, Cathelineau X, Baumert H, Doublet JD, Guillonneau B. Complications of transperitoneal laparoscopic surgery in urology: Review of 1.311 procedures at a single center. J Urol. 2002; 168(1): 23–6.
Starling ES, Reis LO, VazJuliano R. Extraperitoneal endoscopic radical prostatectomy: How steep is the learning curve? Overheads on the personal evolution technique in 5-years experience. Actas Urological Espanolas. 2010; 34(7): 598–602.
Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T. Laparoscopic versus open radical prostatectomy: A comparative study at single institution. J Urol. 2003; 169: 1689–93.
Guillonneau B, Cathelineau X, Doublet JD, Baumert H, Vallancien G. Laparoscopic radical prostatectomy: Assessment after 550 procedures. Crit Rev Oncol Hematol. 2002; 43: 123–33.
Artibani W, Grosso G, Novara G, Pecoraro G, Sidoti O, Sarti A, et al. Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? Analysis of peri-operative morbidity in two contemporary series in Italy. Eur Urol. 2003; 44: 401–6.