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      Prostatectomía laparoscópica digitalmente asistida Translated title: Finger assisted laparoscopic prostatectomy

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          Abstract

          OBJETIVOS: La prostatectomía laparoscópica es el tratamiento de elección en el cáncer de próstata localizado. Sin embargo la curva de aprendizaje es un auténtico desafío para equipos poco experimentados, por lo que la incidencia de complicaciones y los tiempos operatorios alcanzan límites inadmisibles. A la vista de esta intolerable morbilidad, está claro que hay que ofrecer alguna alternativa a una operación, que prácticamente no se ha modificado desde su descripción inicial en 1998. MÉTODOS: Se pone al paciente en posición de litotomía. Después se cubre con un delantal urológico tal y como hacemos en la resección transuretral. Introducimos hasta la vejiga un beniqué. Hacemos en el periné una mini-incisión por donde insertamos el dedo índice hasta tocar la cara posterior de la próstata y de esta forma la despegamos del recto hasta llegar al cuello vesical y lateralmente hasta los pedículos prostáticos. Seguidamente realizamos la prostatectomía laparoscópica, de forma convencional, pero con gran seguridad y rapidez, porque la parte más difícil de la operación, es decir el despegamiento del recto ya se ha realizado. RESULTADOS: La separación digital del recto de la próstata a través de una mini-incisión perineal, facilita drásticamente la intervención y acorta significativamente el tiempo operatorio, lo que permite además prescindir de alguno de los trócares abdominales No podemos de momento presentar estadísticas, porque nuestra experiencia es preliminar y muy limitada, pero la diferencia en cuanto a dificultad y tiempos operatorios son muy significativos. Además está técnica es igualmente aplicable a la cistectomía laparoscópica. CONCLUSIONES: La prostatectomía laparoscópica es un procedimiento de gran dificultad y con una incidencia de complicaciones, de momento, inaceptables, siendo la perforación del recto quizá el accidente más temible. Por lo que la prostatectomía laparoscópica asistida con el dedo a través del periné, para separar el recto de la próstata, puede dar lugar a una revolución como la que hace una década supuso la cirugía laparoscopia manualmente asistida.

          Translated abstract

          OBJECTIVES: Laparoscopic prostatectomy is the treatment of choice for localized prostate cancer. The learning curve for unexperienced teams is dauntingly steep because it is associated with high incidence of complications and such long operation times that the procedure becomes almost unacceptable. Therefore, we needed to seek an alternative for this operation that has been almost unmodified since first description in 1998. METHODS: The patient is placed in lithotomy position and draped with an urological apron similar to the one used for transurethral resection. A beniqué sound is introduced up to the bladder and a 12 mm incision is made in the perineum, through which we slowly introduce the index finger touching the posterior aspect of the prostate. We advance the finger further longitudinally and laterally separating the rectum all the way to the bladder neck and prostatic pedicles on each side. Having freed the prostate, generally the most hazardous manoeuvre, we can then carry out a conventional laparoscopic prostatectomy, safely and quickly because the most difficult step, rectum dissection, has been carried out. RESULTS: Digital separation of the prostate through a perineal incision facilitates the operation a lot and shortens operation times significantly, allowing us to avoid the use of one or two trocars. At this time, we can not present statistical analysis because our limited experience, but there are significant advantages making the procedure easier and operation time shorter. Furthermore, the technique may also be used for laparoscopic cystectomy. CONCLUSIONS: laparoscopic prostatectomy is considered a very difficult procedure, with an unacceptable high incidence of complications, being rectum perforation the most feared. Therefore, laparoscopic prostatectomy assisted by digital manipulation through a small perineal incision appears to be a most welcome development with benefits similar to those brought ten years ago by introduction of hand assisted laparoscopy.

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          Most cited references17

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          Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge.

          With our extensive experience of transperitoneal laparoscopic prostatectomy, we evaluated the advantages and disadvantages of the extraperitoneal approach by comparing 2 consecutive series of each procedure. We reviewed 200 consecutive procedures performed by 2 surgeons. A total of 100 transperitoneal procedures (designated group 1) were compared to the first 100 extraperitoneal cases (designated group 2). Mean operating time was 173 minutes in group 1 and shorter in group 2 at 163 minutes (p = 0.003). Mean blood loss (360 ml in group 1,375 ml in group 2) and transfusion rates (4% in group 1, 3% in group 2) were equivalent. There were no major complications. Minor complications were 10% in group 1 and 9% in group 2. There was no statistical difference in positive margin rate between groups 1 and 2. The 2 procedures are equivalent in terms of operative, postoperative and pathological data. Each surgeon has to choose considering personal experience, training and standardization.
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            Prostatectomía radical laparoscópica: Revisión del primer año

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              Cistectomía radical y conducto ileal laparoscópico

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                urol
                Archivos Españoles de Urología (Ed. impresa)
                Arch. Esp. Urol.
                INIESTARES, S.A. (, , Spain )
                0004-0614
                April 2005
                : 58
                : 3
                : 233-237
                Affiliations
                [01] Málaga orgnameUniversidad de Málaga orgdiv1Facultad de Medicina orgdiv2Departamento de Cirugía España
                Article
                S0004-06142005000300008
                10.4321/s0004-06142005000300008
                b874ba19-86bd-4606-8da1-10d52fb4cd06

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 5
                Product

                SciELO Spain


                Prostatectomía,Laparoscopia,Dedo,Asistida,Periné,Cáncer de próstata,Prostatectomy,Laparoscopy,Finger assisted,Perineum,Prostate cancer

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