Comparison of the Surgical Aspects and Outcomes Between Lateral Approach-Laparoscopic Radical Prostatectomy and Anterior Approach-Laparoscopic Radical Prostatectomy: First Report in Thailand
Abstract
Objective: The present study assesses the overall safety, perioperative outcomes, and early functional results after Lateral Approach-Laparoscopic Radical Prostatectomy (LA-LRP) with a new approach for radical prostatectomy and compares it with Anterior Approach-Laparoscopic Radical Prostatectomy (AA-LRP).
Material and Methods: Two hundred thirty-one patients with localized prostate cancer (clinical T1-T2) underwent laparoscopic radical prostatectomy (LRP) performed by a single surgeon between October 2012 and March 2023 in Rajavithi Hospital: AA-LRP 107 cases and the LA-LRP 124 cases. The demographic data of each group were recorded, along with: prostate-specific antigen PSA, clinical staging, operative time, blood loss, date of ambulation, pathological outcome, length of hospital stay, date of catheter removal, continent recovery rate, and complications.
Results: Most of the patients with clinical T1 and T2 stages who presented with the Gleason grade group at biopsy were in grade groups 1-2. The mean operative time was 483±156 minutes in the AA-LRP group and 348±96 minutes in the LA-LRP group (p-value<0.01). The length of stay and post-operative mean catheter times were 12.26±6.8 days in the AA-LRP group and 9.3±4.4 days in the LA-LRP group (p-value<0.01). Postoperative continence recovery at 12 months after AA-LRP and LA-LRP were 78.8% and 80%, respectively (p-value=0.94). The complication rate was 24.6% in the AA-LRP group and 1.6 % in the LA-LRP group (p-value<0.01).
Conclusion: LA-LRP is one option for treating prostate cancer. Compared with AA-LRP, it provides less blood loss, shorter operative times, fewer complications, and faster recovery without diminishing the oncologic outcomes. However, LA-LRP requires more cases for a surgeon to become proficient, and the long-term consequences need to be observed.
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