J Med Assoc Thai 2007; 90 (4):730

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Nerve-Sparing Laparoscopic Radical Prostatectomy at Siriraj Hospital
Srinualnad S Mail, Nualyong C

Background: Quality of life after laparoscopic radical prostatectomy has been a discussed issue among patients. Nerve-sparing radical prostatectomy has been shown to be superior to non-nerve-sparing radical prostatectomy in terms of potency and continence. The authors have reported their experience of laparoscopic radical prostatectomy and now developed our technique of nerve-sparing laparoscopic radical prostatectomy.
Objective: To evaluate the feasibility of nerve-sparing laparoscopic radical prostatectomy done at our institute.
Material and Method: From December 2005 to August 2006, 28 patients with localized prostate cancer underwent a nerve-sparing laparoscopic radical prostatectomy. Perioperative data was compared to those 34 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy during the same period. All patients had PSA of less than 10 and pre-operative Gleason Score of 7 or less. Quality of life including incontinence and impotency rates was analyzed during three months post-operation.
Results: Patients’ dermographic data, except ages, was similar in the two groups. Operating time was not different (217 vs. 212 minutes in favor of nerve-sparing). Blood loss was significantly high in nerve-sparing laparoscopic radical prostatectomy (814 mls vs. 543 mls, p = 0.01). Tumor control was not different within both groups. Three months after surgery incontinent rates of both groups were not different. 43.75% of patients with nerve-sparing technique had experienced erection at three months after surgery.
Conclusion: The authors’ early experience has shown that nerve-sparing laparoscopic radical prostatectomy does not compromise cancer control, although blood loss is higher. This operation should be encouraged in cancer-localized patients as the patients may gain benefit of better quality of life.

Keywords: Nerve sparing laparoscopic radical prostatectomy, Prostate cancer, Laparoscopy, impotency


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