Several years ago, Stolzenburg and colleagues at the University of Leipzig in Germany developed a form of laparoscopic prostate cancer surgery that they refer to as endoscopic extraperitoneal radical prostatectomy or EERPE. The basic difference between this technique and the forms of laparoscopic prostatectomy (robotic or non-robotic) commonly carried out in the USA involve the direction from which the surgeon approaches the prostate.
In the “transperitoneal” approach that is commonly used in the USA, the surgeon operates by coming through the peritoneal cavity. In Stolzenburg’s method, the surgeon avoids the peritoneal cavity by creating a “preperitoneal space.” Stolzenburg’s original technique was described in 2002, and this year his team published a description of a new nerve-sparing version of this procedure.
Now Stolzenburg and his colleagues have published the results of this technique on their first 2,000 patients:
- The average age of the patients was 63.2 years (with a range from 41 to 77 years).
- The average preoperative PSA was 10.2 ng/ml (0.64-82 ng/ml).
- 601 patients had undergone previous surgery (which we assume to refer largely to a transurethral resection of the prostate or TURP for treatment of BPH).
- The average operation time was 156 minutes (50-320 minutes).
- Positive surgical margins were found in 127 patients with pT2 stage (9.7 percent) and in 237 patients with pT3 stage (34.4 percent).
- Of the 937 pelvic lymph node dissections carried out, 44 (4.7 percent) were positive.
- The average postoperative catheterization time was 6.3 days.
- After 12 months, 92 percent of the patients were completely continent, 7 percent needed 1-2 pads/day, and 1 percent used > 2 pads daily.
- 730 patients underwent a nerve-sparing procedure.
- The 12-month potency rates with or without administration of PDE5 inhibitors (e.g., Viagra) were 34.1 percent in the patients who had just one nerve spared and 67.7 percent in the patients who had both nerves spared.
In this paper Stolzenburg et al. also give results specific to the group of patients who received treatment using the most recent evolution of his nerve-sparing technique (the co-called “intrafascial nsEERPE” technique):
- After 12 months, 93.2 percent of the patients were completely continent, 7.1 percent required 1-2 pads per day, and 0.6 percent > 2 pads per day.
- The 12-month potency rate for unilateral and bilateral nerve sparing using the intrafascial procedure was 33.3 percent and 78.5 percent, respectively.
- The rate of positive surgical margins was 6.3 percent in pT2 and 21.2 percent in pT3 specimens.
Whether Stolzenburg’s technique is any better than the transperitoneal procedure customary in the USA is likely to be less important than the skill of the individual surgeon carrying out whichever technique they have the most experience with. However, we now have another large published series demonstrating that high levels of post-surgical continence and reasonably high levels of potency are achievable using laparoscopic surgical techniques.
Filed under: Treatment | Tagged: laparoscopic surgery EERPE
Several years ago, Stolzenburg and colleagues at the University of Leipzig in Germany developed a form of laparoscopic prostate cancer surgery that they refer to as endoscopic extraperitoneal radical prostatectomy or EERPE. The basic difference between this technique and the forms of laparoscopic prostatectomy (robotic or non-robotic) commonly carried out in the USA involve the direction from which the surgeon approaches the prostate.
In the “transperitoneal” approach that is commonly used in the USA, the surgeon operates by coming through the peritoneal cavity. In Stolzenburg’s method, the surgeon avoids the peritoneal cavity by creating a “preperitoneal space.” Stolzenburg’s original technique was described in 2002, and this year his team published a description of a new nerve-sparing version of this procedure.
Now Stolzenburg and his colleagues have published the results of this technique on their first 2,000 patients:
- The average age of the patients was 63.2 years (with a range from 41 to 77 years).
- The average preoperative PSA was 10.2 ng/ml (0.64-82 ng/ml).
- 601 patients had undergone previous surgery (which we assume to refer largely to a transurethral resection of the prostate or TURP for treatment of BPH).
- The average operation time was 156 minutes (50-320 minutes).
- Positive surgical margins were found in 127 patients with pT2 stage (9.7 percent) and in 237 patients with pT3 stage (34.4 percent).
- Of the 937 pelvic lymph node dissections carried out, 44 (4.7 percent) were positive.
- The average postoperative catheterization time was 6.3 days.
- After 12 months, 92 percent of the patients were completely continent, 7 percent needed 1-2 pads/day, and 1 percent used > 2 pads daily.
- 730 patients underwent a nerve-sparing procedure.
- The 12-month potency rates with or without administration of PDE5 inhibitors (e.g., Viagra) were 34.1 percent in the patients who had just one nerve spared and 67.7 percent in the patients who had both nerves spared.
In this paper Stolzenburg et al. also give results specific to the group of patients who received treatment using the most recent evolution of his nerve-sparing technique (the co-called “intrafascial nsEERPE” technique):
- After 12 months, 93.2 percent of the patients were completely continent, 7.1 percent required 1-2 pads per day, and 0.6 percent > 2 pads per day.
- The 12-month potency rate for unilateral and bilateral nerve sparing using the intrafascial procedure was 33.3 percent and 78.5 percent, respectively.
- The rate of positive surgical margins was 6.3 percent in pT2 and 21.2 percent in pT3 specimens.
Whether Stolzenburg’s technique is any better than the transperitoneal procedure customary in the USA is likely to be less important than the skill of the individual surgeon carrying out whichever technique they have the most experience with. However, we now have another large published series demonstrating that high levels of post-surgical continence and reasonably high levels of potency are achievable using laparoscopic surgical techniques.
Several years ago, Stolzenburg and colleagues at the University of Leipzig in Germany developed a form of laparoscopic prostate cancer surgery that they refer to as endoscopic extraperitoneal radical prostatectomy or EERPE. The basic difference between this technique and the forms of laparoscopic prostatectomy (robotic or non-robotic) commonly carried out in the USA involve the direction from which the surgeon approaches the prostate.
In the “transperitoneal” approach that is commonly used in the USA, the surgeon operates by coming through the peritoneal cavity. In Stolzenburg’s method, the surgeon avoids the peritoneal cavity by creating a “preperitoneal space.” Stolzenburg’s original technique was described in 2002, and this year his team published a description of a new nerve-sparing version of this procedure.
Now Stolzenburg and his colleagues have published the results of this technique on their first 2,000 patients:
In this paper Stolzenburg et al. also give results specific to the group of patients who received treatment using the most recent evolution of his nerve-sparing technique (the co-called “intrafascial nsEERPE” technique):
Whether Stolzenburg’s technique is any better than the transperitoneal procedure customary in the USA is likely to be less important than the skill of the individual surgeon carrying out whichever technique they have the most experience with. However, we now have another large published series demonstrating that high levels of post-surgical continence and reasonably high levels of potency are achievable using laparoscopic surgical techniques.
Filed under: Treatment | Tagged: laparoscopic surgery EERPE
Several years ago, Stolzenburg and colleagues at the University of Leipzig in Germany developed a form of laparoscopic prostate cancer surgery that they refer to as endoscopic extraperitoneal radical prostatectomy or EERPE. The basic difference between this technique and the forms of laparoscopic prostatectomy (robotic or non-robotic) commonly carried out in the USA involve the direction from which the surgeon approaches the prostate.
In the “transperitoneal” approach that is commonly used in the USA, the surgeon operates by coming through the peritoneal cavity. In Stolzenburg’s method, the surgeon avoids the peritoneal cavity by creating a “preperitoneal space.” Stolzenburg’s original technique was described in 2002, and this year his team published a description of a new nerve-sparing version of this procedure.
Now Stolzenburg and his colleagues have published the results of this technique on their first 2,000 patients:
In this paper Stolzenburg et al. also give results specific to the group of patients who received treatment using the most recent evolution of his nerve-sparing technique (the co-called “intrafascial nsEERPE” technique):
Whether Stolzenburg’s technique is any better than the transperitoneal procedure customary in the USA is likely to be less important than the skill of the individual surgeon carrying out whichever technique they have the most experience with. However, we now have another large published series demonstrating that high levels of post-surgical continence and reasonably high levels of potency are achievable using laparoscopic surgical techniques.