Radical prostatectomy is the gold standard treatment for localized prostate
cancer. The laparoscopic surgery approach offers the benefits of Videosurgery in
which the image magnification allows a better identification of structures,
associated with less surgical aggression, driven by a minimally invasive
approach. Using this approach allows not only the maintenance of the oncologic
criteria of open surgery, but also maximizes the preservation of sexual function
and continence.
In 1998, Guillonneau and Vallencien described the first large series of LRP by
transperitoneal approach, demonstrating that, after reaching the learning curve,
one can perform the procedure with an operative time similar to that of open
surgery, maintaining good oncological and functional results and with less
bleeding. Since then, many groups in Europe and also in the United States began
to perform the procedure.
A major drawback that hangs over the transperitoneal technique described by the
French team Montsori is that they transformed a surgery done via extraperitoneal
in the conventional technique in a transperitoneal surgery with the inherent
possibility, of visceral lesions and drainage of fluid into the peritoneum
postoperatively with this kind of technique. To avoid these drawbacks, the
surgery performed by the extraperitoneal approach has gained wide acceptance
worldwide.
Laparoscopic radical prostatectomy is a highly complex procedure, with an
obvious learning curve. During the learning period, complications such as
bleeding, injury to the rectum, urinary fistulas, among others, have been
described in virtually all series. The determination of factors that can reduce
surgical morbidity in this period is critical and has important practical
applicability. Some papers describe that beginning operating after laparoscopic
training in experimental models, operating assisted by a skilled mentor,
selecting cases with lower body mass index, small prostates, and finally
avoiding cases with previous hernioplasty or transurethral resection are
effective tactics to reduce complications during the learning curve.
The purpose of this course is therefore to provide advanced training in
Laparoscopic Extraperitoneal Prostatectomy in order to give the surgeon
intraoperative practice with this type of procedure and to enable the
application of acquired knowledge in their clinical routine.