Introduction: In 1999, Guillonneau and Vallancien presented a refined approach of a descending laparoscopic radical prostatectomy which based mainly on the primary access to the seminal vesicles and an improved suturing and knotting technique. Based on our own experience reconstructive laparoscopy as well as with open retropubic radical prostatectomy we have used a combined ascending/descending technique similar to open surgery. In this paper we want to describe our approach and to present the initial results with the Heilbronn technique. Materials and Methods: A transperitoneal approach is used with a W–shaped arrangement of the trocars (13–mm umbilical port, 2×10 mm medial, 2×5 mm lateral ports). After the exposure of the Retzius’ space and control of the dorsal vein complex the urethra is incised and the distal pedicles of the prostate (± the neurovascular bundle) are transsected. We now pull the apex ventrally and start with the incision at the bladder neck followed by a transvesical access to both vasa deferentia and seminal vesicles. The gland is entrapped in the Extraction Bag®. After accomplishing the posterior wall of the urethrovesical anastomosis with five interrupted sutures, the foley catheter is placed into the bladder and the bladder neck is closed. Now the prostate is extracted via the umbilical incision. From March 1999 to June 2000, we have performed 100 cases (48 pT2–, 47 pT3– and 5 pT4 tumors). The mean preoperative PSA was 26.8 (1.4–75.5) ng/ml. Two tumors were grade 1, 72 grade 2 and 26 grade 3. Median Gleason score was 6 (3–9). All specimen were inked and examined according to the Stanford protocol. Postoperative continence was evaluated using a questionnaire monitored by a colleague who was involved in surgery. Results: We had 5 conversions (rectal injury, difficult dissection, adhesion, 2× bleeding at the dorsal vein complex). The mean operating time was 278 (180–500) min., the transfusion rate 31%. One patient required reintervention due to bleeding from the right obturator fossa. 95% of the patients did not require any analgesia on the second postoperative day. Positive margins were found in 17% of the patients, of which 12 had a PSA nadir to a value of less than 0.1 ng/ml within 3 weeks after surgery. In 82 patients, the anastomosis was tight after removal of the catheter, median catheter time was 8 (6–30) days. 4% developed a stricture at the anastomotic site which could be treated by laserincision. On discharge 33% were continent, after 6 months 81%, whereas only 2 patients still suffer from grade II stress incontinence at 9 months. Conclusions: Laparoscopic radical prostatectomy is feasable but requires laparoscopic expertise. Its learning curve is still ongoing. Morbidity is low, oncological control is similar to results of open surgery, functional results are promising.

Schuessler WW, Kavoussi LR, Clayman RV, Vancaille TH: Laparoscopic radical prostatectomy: Initial case report. J Urol 1992;147:246 A(abstr 130).
Schuessler W, Schulam P, Clayman R, Kavoussi L: Laparoscopic radical prostatectomy: Initial short–term experience. Urology 1997;50: 854–857.
Guillonneau B, Cathelineau X, Baret E, Rozet F, Vallancien G: Laparoscopic radical prostatectomy: Technical and early oncological assessment of 40 operations. Eur Urol 1999;36: 14–20.
Frede T, Stock C, Renner C, Budair Z, Abdel–Salam Y, Rassweiler J: Geometry of laparoscopic suturing and knotting techniques. J Endourol 1999;13:191–198.
Walsh P, Partin A, Epstein JI: Cancer control and quality of life following anatomical radical retropubic prostatectomy: Results at 10 years. J Urol 1994; 152:1831–1836.
Zincke H, Oesterling J, Blute M, Bergstrahl E, Myers R, Barret D: Long–term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol 1994;152:1850–1857.
Davidson P, van den Ouden D, Schroeder F: Radical prostatectomy: Prospective assessment of mortality and morbidity. Eur Urol 1996;29:168–173.
Dillioglugi O, Leibman B, Leibman N, Kattan M, Rosas A, Scardino P: Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 1997;157:1760– 1767.
Paulsson DF: Impact of radical prostatectomy in the management of clinically localized disease. J Urol 1994;152:1826–1831.
Weldon VE, Tavel FR, Neuwirth H, Cohen R: Pattern of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. J Urol 1995;153: 1565–1570.
Catalona WJ, Dresner SM: Nerve–sparing radical prostatectomy: extraprostatic tumor extension and preservation of errectile function. J Urol 1993;150:1845–1850.
Kavoussi LR, Schuessler WW, Vancaille TG, Clayman RV: Laparoscopic approach to the seminal vesicles. J Urol 1993;150:417–420.
Abbou CC, Antiphon P, Salomon L, Hoznek A, Bellot J, Lefrere–belda MA, Chopin DK: Laparoscopic radical prostatectomy: Preliminary results. J Endourol 1999;13:A–45(abstr FP6–10).
Raboy A, Ferzli G, Albert P: Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology 1997;50:849– 853.
Hatzinger M, Seemann O, Grenacher L, Rassweiler J: Laparoscopy–assisted penile revascularization: A new method. J Endourol 1997;11: 269–272.
Gill IS, Albala DM, Aso Y, Chiu AW, Clayman RV, Das S, Donovan JF, Fuchs GJ, Gaur DD, Go H, Gomella LG, Grune MT, Harewood LM, Janetschek G, Knapp PM, McDougall EM, Nakada SY, Preminger GM, Puppo P, Rassweiler JJ, Royce PL, Thomas R, Urban DA, Winfield HN: Retroperitoneal and pelvic extraperitoneal laparoscopy: An international perspective. Urology 1998;52:566–571.
Guillonneau B, Vallancien G: Laparoscopic radical prostatectomy: The Montsouris experience. J Urol 2000;163:418–422.
Jacob F, Salomon L, Hoznek A, Bellot J, Antiphon P, Chopin DK, Abbou CC: Laparoscopic radical prostatectomy: Preliminary results. Eur Urol 2000;37:615–620.
Stamey TA, McNeal JE, Freiha FS, Redwine E: Morphometric and clinical studies in 68 consecutive radical prostatectomies. J Urol 1988;139:1235–1241.
Winfield HN, Donovan JF, See WA, Loening SA, Williams RD: Laparoscopic pelvic lymph node dissection for genitourinary malignancies: Indications, techniques and results. J Endourol 1992;6:103–112.
Rassweiler JJ, Tschada R, Henkel TO, Greschner M, Seemann O, Jünemann KP, Alken P: Trans– und extraperitoneale laparoskopische pelvine Lymphadenektomie: Technik, Indikationen und erste Erfahrungen. Min Inv Chir 1994;3:140–148.
Kavoussi LR, Sosa E, Chandhoke P, Chodak G, Clayman RL, Hadley HR, Loughlin KR, Ruckle HC, Rukstalis D, Schuessler W, Segura J, Vancaille T, Winfield H: Complications of laparoscopic pelvic lymph node dissection. J Urol 1993;149:322–323.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.