LAPAROSCOPIC RADICAL PROSTATECTOMY FOR HIGH RISK LOCALIZED AND LOCALLY ADVANCED DISEASE
MARCOS TOBIAS-MACHADO, EDUARDO S. STARLING, ALEXANDRE STIEVANO CARLOS, ANTONIO C. L. POMPEO, PEDRO ROMANELLI, RICARDO NISHIMOTO
Department of Urology, ABC Medical School, Santo André (MTM, ESS, ASC, ACLP), SP, Brazil and Minas Gerais Military Hospital, Belo Horizonte (PR, RN), MG, Brazil
Background: Penile cancer is a rare disease, most commonly encountered in developing countries. It constitutes 0.4% of cancers in U.S. men and 2.1% in Brazil, with the highest prevalence in the North and Northeast regions. Inguinal lymph node metastasis of penile cancer occurs in 20 to 40% of patients and is an important predictor of cancer-specific mortality. The preferred diagnostic and therapeutic tool to assess the regional lymph nodes is a lymphadenectomy which can, in addition to establishing staging, offers curative potential.
Int Braz J Urol. 2012; 38 (Video #3): 430-431
The authors describe and then demonstrate the technique of pure laparoscopic radical prostatectomy and extended pelvic lymph node dissection in a patient with high risk prostate cancer. They appropriately comment that surgery is able to achieve reasonable cancer control in this challenging group of patients with aggressive cancers. They clearly address the two main surgical principles that allow optimizing the procedure: Wide excision of the neurovascular bundles and bladder neck and the completion of an extended lymph node dissection. The video demonstrates the gross appearance of an adequately performed lymph node dissection on the left side with clear anatomical definition of the distal common iliac vessels, full mobilization of the external iliac artery and vein and a clean obturator fossa. More importantly, they demonstrate that the procedure may be performed safely and efficiently through a pure laparoscopic approach in centers with surgeons experienced in advanced laparoscopy and without the need of the robot. This is of relevance as many centers in Latin America currently do not have access to robotic technology.
Dr. Julio Pow-Sang