LAPAROSCOPIC RADICAL PROSTATECTOMY WITH EXTENDED LYMPHADENECTOMY FOR TREATMENT OF HIGH RISK PROSTATE CANCER

Abstract

Laparoscopic preperitoneal radical prostatectomy (LPPRP) is a safe and reproducible technique. High risk prostate cancer requires an extended lymphadenectomy. A transperitoneal approach allows to combine mininvasive procedure with an extended lymphadenectomy. A transperitoneal approach is realized. Pelvic bilateral pelvic lymphadenectomy is performed including iliac and obturator nodes. We proceed with dissection between bladder and prostate; endopelvic fascia is opened and separated by prostate. Bladder neck is spared and urethra is cut. Dissection moves to a depth plane towards Denonvilliers fascia; deferens vas are isolated, clipped and then cut. Mobilization of seminal vesicles and incision of Denonvilliers' fascia. Section of the prostatic pedicles is realized with Harmonic Acetm . Lateral blunt dissection proceed towards prostatic apex. Urethra is cut and the prostate is placed in endobag. A water-tight urethrovesical anastomosis with running suture is performed. A transperitoneal laparoscopic radical prostatectomy allows to combine mininvasive procedure with an extended lymphadenectomy.