In the United States, prostate cancer is the most frequently diagnosed solid tumor among men.<sup>25 Landis S., Murray T., Bolden S. , et al. Cancer statistics, 1999 CA Cancer J Clin 1999 ;  9 : 8  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Treatment options for tumors clinically confined to the prostate include radical prostatectomy, external beam radiotherapy, brachytherapy, cryotherapy, or expectant management, and each of these therapies is associated with a different morbidity profile. The morbidity for radical prostatectomy includes a hospital stay averaging 2 to 3 days, postoperative pain, prolonged urethral catheterization (>10 days), the risk for incontinence, and the possibility of erectile dysfunction.

To reduce the morbidity of conventional prostatectomy and to improve operative precision, several groups recently have advocated a laparoscopic technique.<sup>3 Abbou C., Antiphon P., Salomon L. , et al. Laparoscopic radical prostatectomy: Preliminary results J Endourol 1999 ;  13 : A45

Cliquez ici pour aller à la section Références, 19 Guillonneau B., Cathelineau X., Barret E. , et al. Short term functional results of laparoscopic radical prostatectomy: Statement after 100 first procedures J Endourol 1999 ;  13 : A95

Cliquez ici pour aller à la section Références</sup> In comparison with a variety of open surgical procedures, laparoscopy has demonstrated a significant advantage in reducing postoperative discomfort, hospital stay, and convalescence<sup>7 Brooks J., Kavoussi L., Preminger G. , et al. Comparison of open and endourologic approaches to the obstructed ureteropelvic junction Urology 1995 ;  46 : 791  [cross-ref]

Cliquez ici pour aller à la section Références, 13 Flowers J., Jacobs S., Cho E. , et al. Comparison of open and laparoscopic live donor nephrectomy Ann Surg 1997 ;  226 : 483  [cross-ref]

Cliquez ici pour aller à la section Références, 23 Kerbl K., Clayman R., McDougall E. , et al. Transperitoneal nephrectomy for benign disease of the kidney: A comparison of laparoscopic and open surgical techniques Urology 1994 ;  43 : 607  [cross-ref]

Cliquez ici pour aller à la section Références</sup>; however, longitudinal evaluation of the oncologic and functional results is imperative before the laparoscopic approach can be offered as an alternative standard of care. For some laparosocpic procedures (i.e., gynecologic oncologic procedures, bladder neck suspension), equivalency in these parameters has not been attained.<sup>11 Childers J., Aqua K., Surwit E. , et al. Abdominal-wall tumor implantation after laparoscopy for malignant conditions Obstet Gynecol 1994 ;  84 : 765

Cliquez ici pour aller à la section Références, 28 McDougall E., Heidorn C., Portis A. , et al. Laparoscopic bladder neck suspension fails the test of time J Urol 1999 ;  162 : 2078  [cross-ref]

Cliquez ici pour aller à la section Références</sup>

Laparoscopic radical prostatectomy (LRP) must be scrutinized carefully in comparisons. The standard open procedure has a solid track record and well-defined morbidity. Before it can be advocated as a reasonable alternative, LRP must match the contemporary oncologic results and low morbidity of open radical prostatectomy. It must demonstrate adequacy of surgical margins, the absence of significant risk for trocar site implantation, and similar progression-free and disease-specific survival rates.

Purported advantages of laparoscopy in reducing surgical morbidity also need to be compared with open radical prostatectomy in areas such as hospital stay, postoperative discomfort (including catheterization time), blood loss/transfusion requirements, incontinence, impotence, time to convalescence, operative time, and cost. Each of these parameters needs to be evaluated systematically before LRP can be advocated as a reasonable surgical alternative for clinically localized prostate cancer.