V475 MODIFICATION OF APICAL DISSECTION TECHNIQUE IN LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Oncology1 Apr 2010V475 MODIFICATION OF APICAL DISSECTION TECHNIQUE IN LAPAROSCOPIC RADICAL PROSTATECTOMY Rodrigo Pinochet, Ari Adamy, Jorge Rioja, Lucas Nogueira, Daher Chade, Caroline Savage, Andrew Vickers, Karim Touijer, and Bertrand Guillonneau Rodrigo PinochetRodrigo Pinochet More articles by this author , Ari AdamyAri Adamy More articles by this author , Jorge RiojaJorge Rioja More articles by this author , Lucas NogueiraLucas Nogueira More articles by this author , Daher ChadeDaher Chade More articles by this author , Caroline SavageCaroline Savage More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Karim TouijerKarim Touijer More articles by this author , and Bertrand GuillonneauBertrand Guillonneau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.549AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the impact of a modified technique of apical dissection during Laparoscopic Radical Prostatectomy on continence outcomes. METHODS 813 patients with clinically localized prostate cancer (cT1c-cT3a) underwent LRP between 2004 and 2007. Before December 2005, patients received the classical technique of apical dissection described at Montsouris, controlling the Dorsal Vein Complex (DVC) with a stitch and then dissecting the periurethral tissue (Old technique). After January 1st 2006 all patients underwent a new apical dissection technique, doing a sharp DVC dissection using transitory high pressure pneumoperitoneum (20 mmHg) to control bleeding and avoid excessive dissection. The visible veins are sutured selectively closing their lumens. At the end of the vesico-urethral anastomosis a bladder neck suspension is done by suturing the anastomosis with the puboprostatic ligament. Continence was assessed using self-reported questionnaires. By estimating the learning curve for the old technique and extrapolating to more recently treated patients, we were able to compare the actual outcome for patients who received the new technique with their expected outcome had they been treated using the old technique. RESULTS Of the 534 patients followed for continence 252 (47%) received the new technique. We found no evidence that the new technique was associated with improved continence rates at 6 months (actual rate of continence= 39%; expected rate of continence=35%; absolute improvement 5%; 95% C.I. -16%, 26%; p=0.7); however, the new technique was associated with improved continence rates at 12 months (actual rate of continence= 69% vs expected rate of continence= 47%; absolute improvement 22%; 95% C.I. 3%, 41%; p=0.021). CONCLUSIONS Our results indicate the new technique improves overall continence rates, but not early recovery of continence. The learning curve is an important confounder in the analysis of the change of surgical technique and needs to be accounted for appropriately. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e187 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodrigo Pinochet More articles by this author Ari Adamy More articles by this author Jorge Rioja More articles by this author Lucas Nogueira More articles by this author Daher Chade More articles by this author Caroline Savage More articles by this author Andrew Vickers More articles by this author Karim Touijer More articles by this author Bertrand Guillonneau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...