Abstract
Laparoscopic radical prostatectomy（LRP）has the advantages of intraoperative bleeding and magnified view comparing to retropubic radical prostatectomy （RRP）. Anatomical understanding due to its magnified view has lead to many modifications and improvements of surgical technique. Recently, continence, potency and cancer control, named trifecta, are thought to be the surgical endpoint of radical prostatectomy. Outcome of LRP has been reported to be comparative to that of RRP in recent reports. However, the factors influenced continence recovery have not been elucidated completely and number of improvements such as intrafascial nerve-sparing and reconstruction of rhabdosphincter, have been reported to achieve early continence recovery. Long-term outcome after LRP has not been evaluated well. In this report, surgical outcome including trifecta after LRP in the literatures was reviewed and compared to that of our institute. From January 2007, 232 patients were performed LRP in Jikei University Hospital. Nerve-sparing surgery was performed in 165 patients. Positive surgical margin rate was 28.9% in all and 15.4% in pT2 cases. Continence was recovered in more than 95% of patients 1 year after surgery. Patients performed nerve-sparing surgery showed significant earlier continence recovery comparing to patients without nerve-sparing. Nerve-sparing surgery also showed significant advantage for sexual function recovery after surgery. From the point of view of trifecta, surgical outcome of LRP seems to be comparative to RRP. Further improvements for the recovery of sexual function are required to achieve higher level of trifecta.
