Rigi10™ Malleable Penile Prosthesis
Also Known As
LRP (Laparoscopic Radical Prostatectomy), LP (Laparoscopic Prostatectomy), Minimally Invasive Radical Prostatectomy, Keyhole Prostate Surgery, Endoscopic Radical Prostatectomy, Laparoscopic Total Prostatectomy
Definition
Laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical procedure for the treatment of localized prostate cancer. This technique involves the complete removal of the prostate gland, seminal vesicles, and surrounding tissues through several small incisions in the abdomen, using specialized instruments and a camera (laparoscope) that provides magnified visualization of the surgical field.1 2
The procedure was first introduced in the 1990s as an alternative to traditional open radical retropubic prostatectomy, with the aim of replicating oncological outcomes while reducing the morbidity associated with open surgery.1 3 Since its introduction, laparoscopic radical prostatectomy has undergone numerous modifications in surgical technique, including approach variations (transperitoneal versus extraperitoneal), anterior and posterior dissection methods, and ascending and descending dissection techniques.1
In the transperitoneal approach, access to the prostate is gained through the peritoneal cavity, typically using five laparoscopic ports arranged in a fan array.2 The extraperitoneal approach provides direct access to the space of Retzius without entering the peritoneal cavity, which may reduce the risk of bowel complications and intra-abdominal organ damage.3 Both approaches have demonstrated comparable outcomes, with selection often based on surgeon preference and patient-specific factors.4
The procedure involves several key steps: creation of pneumoperitoneum or pneumoextraperitoneum, development of the space of Retzius, incision of the endopelvic fascia, control of the dorsal venous complex, bladder neck dissection, seminal vesicle and vas deferens dissection, nerve-sparing dissection when appropriate, prostate apex dissection, and vesicourethral anastomosis.2 3 5
Compared to open radical prostatectomy, laparoscopic radical prostatectomy offers several potential advantages, including reduced blood loss, shorter hospital stay, decreased postoperative pain, faster recovery, and improved cosmetic results.6 7 However, the procedure requires significant technical expertise and is associated with a steep learning curve for surgeons.8
More recently, robotic-assisted radical prostatectomy (RARP) has emerged as an evolution of laparoscopic techniques, offering three-dimensional visualization and enhanced instrument dexterity. Multiple studies have compared outcomes between LRP and RARP, with some evidence suggesting that RARP may offer advantages in functional outcomes such as urinary continence and erectile function recovery.9
Clinical Context
Laparoscopic radical prostatectomy (LRP) is primarily indicated for the treatment of clinically localized prostate cancer (stages T1 and T2).1 2 The procedure has gained significant acceptance as a minimally invasive alternative to traditional open radical prostatectomy, particularly with the increasing detection of early-stage prostate cancer through PSA screening.3
Patient selection is crucial for optimal outcomes with LRP. The best candidates are patients with clinically localized prostate cancer who are generally age 70 or younger.4 Patients should have a reasonable life expectancy (typically at least 10 years) to benefit from the procedure’s cancer control benefits.5 Preoperative assessment includes digital rectal examination, PSA testing, prostate biopsy with Gleason score determination, and appropriate imaging studies to evaluate the extent of disease.6
Relative contraindications for LRP include multiple previous lower abdominal surgeries (which may increase the risk of adhesions and complicate the laparoscopic approach), morbid obesity, prior radiation treatment to the pelvis, and uncorrected coagulopathy.4 Additionally, patients with large prostate glands (typically >100g) may present technical challenges, though this is not an absolute contraindication in experienced hands.7
The surgical procedure involves several key steps: patient positioning in the Trendelenburg position, establishment of pneumoperitoneum or pneumoextraperitoneum, port placement, development of the space of Retzius, incision of the endopelvic fascia, control of the dorsal venous complex, bladder neck dissection, seminal vesicle and vas deferens dissection, nerve-sparing dissection when appropriate, prostate apex dissection, and vesicourethral anastomosis.8 9
Perioperative outcomes of LRP include reduced blood loss (typically 200-300 mL), shorter hospital stays (1-3 days), decreased postoperative pain, and faster recovery compared to open radical prostatectomy.10 11 The catheterization period typically ranges from 5 to 10 days.12
Functional outcomes include continence rates of 83.6% to 92% at 12 months post-surgery.13 Potency rates after bilateral nerve-sparing LRP range from 47.1% to 67%, depending on patient age, preoperative erectile function, and extent of nerve preservation.13 14
Oncologic outcomes are comparable to those of open surgery, with positive surgical margin rates ranging from 2.1-6.9% for pT2a disease, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b.13 Long-term cancer control appears similar to open radical prostatectomy, though longer follow-up data are still being accumulated.15
More recently, robotic-assisted laparoscopic radical prostatectomy (RALP) has emerged as a technological evolution of conventional LRP, with some studies suggesting potential advantages in functional outcomes, particularly regarding continence and potency recovery rates.16 However, both techniques continue to evolve, and outcomes are highly dependent on surgeon experience and technical expertise.17