Re: Giorgio Guazzoni, Andrea Cestari, Richard Naspro, et al. Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomized, single-surgeon study. Eur Urol 2006;50:98-104.

Home Articles EU Focus EU Supplements Surgery in Motion Resource Centres EAU Guidelines About Social Media Resources for authors Resources for patients Summer Reading Summer Reading EUF Log in Back Letter to the Editor Re: Giorgio Guazzoni, Andrea Cestari, Richard Naspro, et al. Intra- and Peri-Operative Outcomes Comparing Radical Retropubic and Laparoscopic Radical Prostatectomy: Results from a Prospective, Randomized, Single-Surgeon Study. Eur Urol 2006;50:98–104 By: Marco Carinilowast , Lorenzo Masieri, Andrea Minervini and Sergio Serni European Urology, Volume 51 Issue 3, March 2007, Pages 858-859 Published online: 01 March 2007 Abstract Full Text Full Text PDF (54 KB) Share We read with interest the manuscript of Prof. Guazzoni and coworkers who presented a prospective, randomized, single-surgeon comparison in intra-operative and peri-operative outcomes between laparoscopic radical prostatectomy (LRP) and radical retropubic open prostatectomy (RRP) [1]. In this well done study, the authors dissolve the biases of previously published series as differences in surgeons, in surgeons’ experience, in period of specific surgical learning curve, thus demonstrating advantages of the laparoscopic approach especially in reducing intraoperative blood loss and transfusion requirements, and safe early catheter removal. In particular intraoperative bleeding is an important issue, influencing the operative morbidity, and other important outcome of radical prostatectomy, obscuring the operative field and requiring haemostatic sutures that could injure the striated sphincter and neurovascular bundles. In the open prostatectomy group the mean estimated blood loss was 853ml, that is substantially within the average value reported in recent series ranging between 600 and 1200ml [2] and [3]. In the laparoscopic approach the authors showed a substantial decrease in intraoperative blood loss (257ml vs. 853ml, p<0.001), and a significant lower requirements of autologous transfusion (13.3% vs 45%). Possible explanations for the above mentioned data are: optimal visualization and dissection of the prostatic apex, of Santorini plexus and urethra and the tamponade effect due to the pneumoperitoneum. The promising results of the present series appear to be similar enough to the data published in the literature after laparoscopic prostatectomy [4]. We believe that a possible bias in this study could be represented by the different approaches used. Indeed when performing laparoscopic prostatectomy the surgeon used the antegrade technique as described by Guillonneau et al., while using the retrograde approach as described by Walsh for the open prostatectomy [5] and [6]. We systematically adopt the open antegrade retropubic prostatectomy since the mid 80s with nearly a thousand procedures performed in this period of time and strongly believe that although the tamponade effect of the pneumoperitoneum along with images magnification are for sure determinant factors and partly explain the results reported in the present series, the surgical antegrade prostatectomy per se play a fundamental role to reduce intraoperative blood loss [7]. Our data on intraoperative blood loss after antegrade open radical prostatectomy are similar to those reported after laparoscopic prostatectomy (data not published). Indeed during the antegrade surgical approach the Santorinis’ plexus and the apical dissection is performed as final step, and consequently with the maximal exposition of these structures. In conclusion we believe that the antegrade surgical technique per se can reduce intraoperative blood loss and it would be interesting to compare antegrade and retrograde approaches in a prospective randomized study to confirm the reported advantages of the technique and to evaluate the possible further effect on hospital stay and recovery time