, MD, PhD, FEBU . , ,

Schuessler WW, Kavoussi LR, Clayman RV, Vancaille T: Laparoscopic radical prostatectomy: initial case report. J Urol. 1992; 147: 246A

Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR: Laparoscopic radical prostatectomy: initial short-term experience. Urology 1997; 50: 854Department of Urology, Southeast Baptist Hospital, San Antonio, Texas, USA

ResultsBetween September 1991 and May 1995, nine laparoscopic RRPs were performed. The operative time averaged 9.4 hours. Only 1 of 9 patients had a positive surgical margin that involved the urethra. Six of 9 patients were completely continent postoperatively...

ConclusionsLaparoscopic radical prostatectomy is feasible but currently offers no advantage over open surgery with regard to tumor removal, continence, potency, length of stay, convalescence, and cosmetic result.

Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G.: Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol. 1999;36(1):14Department of Urology, Institut Mutualiste Montsouris, Paris, France

Jacob F, Salomon L, Hoznek A, Bellot J, Antiphon P, Chopin DK, Abbou CC.: Laparoscopic radical prostatectomy: preliminary results. Eur Urol. 2000;37(5):615Service d'Urology, Hpital Henri-Mondor, Crteil, France

Rassweiler J, Sentker L, Seemann O, Hatzinger M, Stock C, Frede T.: Heilbronn laparoscopic radical prostatectomy. Technique and results after 100 cases. Eur Urol 2001,40(1):54Department of Urology, Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany

Stolzenburg JU, Do M, Pfeiffer H, Knig F, Aedtner B, Dorschner W: The endoscopic extraperitoneal radical prostatectomy (EERPE): technique and initial experience. World J Urol 2002, 20(1):48University of Leipzig, Department of Urology, Germany

Curto F, Benijts J, Pansadoro A, Barmoshe S, Hoepffner JL, Mugnier C, Piechaud T, Gaston R: Nerve Sparing Laparoscopic Radical Prostatectomy: Our Technique. Eur Urol 2006, 49(2):344Department of Urology, Clinique St. Augustin, Bordeaux, France

Lein M, Stibane I, Mansour R, Hege C, Roigas J, Wille A, Jung K, Kristiansen G, Schnorr D, Loening SA, Deger S: Complications, urinary continence, and oncologic outcome of 1000 laparoscopic transperitoneal radical prostatectomies-experience at the Charit Hospital Berlin, Campus Mitte. Eur Urol 2006, 50(6):1278Department of Urology, Charit Hospital Berlin, Campus Mitte, University Medicine Berlin, Germany

Eden CG, Neill MG, Louie-Johnsun MW: The first 1000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple 'learning curves'. BJU Int 2009, 103(9):1224Department of Urology, The Royal Surrey County Hospital, Guildford, UK

Stolzenburg JU, Kallidonis P, Minh D, Dietel A, Hfner T, Dimitriou D, Al-Aown A, Kyriazis I, Liatsikos EN: Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases. J Endourol. 2009 Sep;23(9):1467University of Leipzig, Department of Urology, Germany

Hruza M, Weiss HO, Pini G, Goezen AS, Schulze M, Teber D, Rassweiler JJ.: Complications in 2200 consecutive laparoscopic radical prostatectomies: standardised evaluation and analysis of learning curves. Eur Urol 2010,58(5):733Department of Urology, Klinikum Heilbronn, University of Heidelberg, Heilbronn, Germany

RALP: 2000

RALP ...: 2000Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO, Vallancien G.: Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol. 2002 Sep;168(3):945Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA

...: >65%

...: >1400

: ~440

5464 RP 2012 : RRP 45% - LRP 26% - RALP 29%

: 7 (?)

Krankenhaus Nordwest, 2005

Dry Wet Animal Labs: 2005 2007 Pelvic trainer: 2005 - 2008

(, , , Linz, ): 2006 - 2009 Training Courses: 2006 - : 2007 - 2008

: 2007( )

: 2008

: 2008

: 2008

522

43 LPLND 479

50 EERPE: : ~ 120min : ~ 3 : 2

EERPE

Stolzenburg JU, McNeill A, Liatsikos EN.: Nerve-sparing endoscopic extraperitoneal radical prostatectomy. BJU Int. 2008 Apr;101(7):909

Santorini

: ( Van Velthoven)

LRP LPLND +

Lattouf JB, Beri A, Jeschke S, Sega W, Leeb K, Janetschek G.: Laparoscopic extended pelvic lymph node dissection for prostate cancer: description of the surgical technique and initial results.Eur Urol. 2007 Nov;52(5):1347

LRP 500 : 184min (100 266) : 151min (50 340) ( LPLND 50% )* RALRP : 180min (130 282) RRP : 152min (120 204)

* Stolzenburg JU, et al.: Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases. J Endourol. 2009 Sep;23(9):1467

LRP & RALP : 50 500ml : 0 6% RRP : 550 1180ml : 11%

LRP & RALP, 77% RRP*

- * Parsons JK, Bennett JL. et al.: Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology. 2008;72:412

nerve sparing ( ) ()p

LRP 3 : 83-90% 5 : 73-75% 5 > 5000 1:91% (pT2) & 82,5% (pT3a) RALRP 5 2,3: 85 - 87% RRP 5 : 72-88% 10 : 64-75%

1 Rassweiler J, et al.: Laparoscopic radical prostatectomy: the experience of the German laparoscopic working group. Eur Urol. 2006;49:113 2 Menon M, et al.: Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384patients with a median 5-year follow-up. Eur Urol. 2010;58:838 3 Sooriakumaran P, et al.: Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum follow-up time of 5 years. Eur Urol. 2012;62:768

( )* LRP: 12,7% ( 34% ) RALRP: 8,3% (1-21%)RRP: 19,4% ( )

(

*( )* Tewari A, et al.: Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012 Jul;62(1):1

LRPRRPRALP ...2,13,11,4 ...6,39,94,0

* :75 (RRP) vs 25 (RALP)

* Coelho RF, et al.: Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers. J Endourol. 2010 Dec;24(12):2003

RRPLRPRALP3 34 68%51 76%50 93%6 39 78%70 95%62 97%12 Weighted means66 93%80%82 95%85%82 97%92%

*( NVB) .. , nerve sparing IIEF - : RALP RP

* Coelho RF, et al.: Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers. J Endourol. 2010 Dec;24(12):2003

RRPLRPRALP12 Weighted means44 72%60%46 82%75%70 80%93%

LRP (n=1277) vs RALP (n=1009)

** Ploussard G, et al.: Comparisons of the Perioperative, Functional, and Oncologic Outcomes After Robot-Assisted Versus Pure Extraperitoneal Laparoscopic Radical Prostatectomy. Eur Urol. 2012 Dec 1. doi:pii: S0302-2838(12)01424-8. 10.1016/j.eururo.2012.11.049. [Epub ahead of print] Department of Urology, Hospital Henri Mondor, Crteil, France.

LRPRALPp value (min)175130

LRP (n=1277) vs RALP (n=1009)

** Ploussard G, et al.: Comparisons of the Perioperative, Functional, and Oncologic Outcomes After Robot-Assisted Versus Pure Extraperitoneal Laparoscopic Radical Prostatectomy. Eur Urol. 2012 Dec 1. doi:pii: S0302-2838(12)01424-8. 10.1016/j.eururo.2012.11.049. [Epub ahead of print] Department of Urology, Hospital Henri Mondor, Crteil, France.

%LRPRALPp value26,6310,038pT216,819,60,513pT341,147,4

LRP (n=1277) vs RALP (n=1009)

** Ploussard G, et al.: Comparisons of the Perioperative, Functional, and Oncologic Outcomes After Robot-Assisted Versus Pure Extraperitoneal Laparoscopic Radical Prostatectomy. Eur Urol. 2012 Dec 1. doi:pii: S0302-2838(12)01424-8. 10.1016/j.eururo.2012.11.049. [Epub ahead of print] Department of Urology, Hospital Henri Mondor, Crteil, France.

: , NVB (LRP RALP)

%LRPRALP6 495912 7283

LRP (n=1277) vs RALP (n=1009)

** Ploussard G, et al.: Comparisons of the Perioperative, Functional, and Oncologic Outcomes After Robot-Assisted Versus Pure Extraperitoneal Laparoscopic Radical Prostatectomy. Eur Urol. 2012 Dec 1. doi:pii: S0302-2838(12)01424-8. 10.1016/j.eururo.2012.11.049. [Epub ahead of print] Department of Urology, Hospital Henri Mondor, Crteil, France.

Potency recovery rates at each medical visit in the laparoscopic radical prostatectomy and in the robot-assisted prostatectomy groups after bilateral nerve-sparing surgery (overall cohort). The p values at each time point were preoperative ( p = 0.716), 1 mo ( p < 0.001), 3 mo ( p = 0.001), 6 mo ( p < 0.001), 12 mo ( p < 0.001) and 24 mo ( p < 0.001).

1. Bolenz C, et al.: Costs of Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur Urol. 2012 Sep 5. doi:pii: S0302-2838(12)01012-3. 10.1016/j.eururo.2012.08.059. [Epub ahead of print]2. Close A, et al.: Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health Service. Eur Urol. 2013 Mar 7. doi:pii: S0302-2838(13)00223-6. 10.1016/j.eururo.2013.02.040. [Epub ahead of print]3. Cooperberg MR, et al.: Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis. BJU Int. 2013 Mar;111(3):437-50.4. Bolenz C, et al.: Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol. 2010 Mar;57(3):453.5. Yu HY, et al.: Use, Costs and Comparative Effectiveness of Robotic Assisted, Laparoscopic and Open Urological Surgery. J Urol. 2012 Apr;187(4):1392-8.6. Al-Shaiji TF, et al.: A cost-analysis comparison of laparoscopic radical prostatectomy versus open radical prostatectomy: the McMaster Institute of Urology experience. Can Urol Assoc J. 2010 Aug;4(4):237-41.

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meta 11 ( 7 ) RRP, LRP RALP

* Hohwu L, et al. A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy. J Med Econ 2011;14:4039.* RALP RRP

RRPLRPRALP $ (10/11)3384 - 97575058 - 67605386 - 11806 (1/11)*3836-8369

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LRP vs. RRP: LRP1,2

RALP: (1,5 2,25 .) (120000 - 170000$ / ) ~2700$, >176 / 1 Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 2000;163:41822.2 Al-Shaiji TF, et al.: A cost-analysis comparison of laparoscopic radical prostatectomy versus open radical prostatectomy: the McMaster Institute of Urology experience. Can Urol Assoc J. 2010 Aug;4(4):237-41.

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computer models: /

ICER* (incremental cost effectiveness ratio): cost / QALYs

NHS, RALP , / > 150 ** Close A, et al.: Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health Service. Eur Urol. 2013 Mar 7. doi:pii: S0302-2838(13)00223-6. 10.1016/j.eururo.2013.02.040. [Epub ahead of print].

LRP elefant: 82 balloon insuflator:98 titanium clips:84 Hem-o-lock:28 retrieval bag:30:322

Ultracision: 790

LRP : ..... ( ...): ~3074 +

..... ( ...) ... .. ... ( , LRP & RRP) 1774 1267 - (LRP) 1300 1800 2000 2500 2500 3500 (RRP) 160020002700 3500

LRPJ Urol. 2010 Dec;184(6):2291-6

LRP : PSM 1

: 2

1Bianco FJ Jr, Riedel ER, Begg CB et al: Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol 2005; 173:2099.2 Eastham JA, Kattan MW, Riedel E et al: Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol 2003; 170:2292.

LRP (modular) LRP 3

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3 Stolzenburg JU, Rabenalt R, Do M et al: Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy. Eur Urol 2006; 49:491.4 Touijer K, Kuroiwa K, Vickers A et al: Impact of a multidisciplinary continuous quality improvement program on the positive surgical margin rate after laparoscopic radical prostatectomy. Eur Urol 2006; 49:853.

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