Feasibility of laparoscopic radical prostatectomy initiation by a surgeon with limited open surgery experience

Due to its greater accessibility and cost-effectiveness, laparoscopic radical prostatectomy (LRP) is widely preferred worldwide. The aim of this study was to evaluate the outcomes of laparoscopy performed with prior limited open surgical experience. It retrospectively compares the initial cases of open radical prostatectomy (ORP) and LRP conducted by a single surgeon. A total of 54 patients were included in the study. From June 2019 to March 2021, 27 patients diagnosed with clinically localized prostate cancer underwent ORP, while from March 2021 to March 2022, 27 patients underwent LRP. Both groups were analyzed retrospectively regarding operative time, blood loss, nerve-sparing surgery, lymph node dissection, postoperative complications, and functional outcomes. There was no significant difference in mean operative time between the groups (266.8 vs 251.8 minutes). The mean blood loss was significantly lower in the LRP group (218.1 vs 987.7 mL, P < .001); 12 patients required blood transfusion in the ORP group. The hospital stay was significantly shorter in the LRP group (5.1 vs 6.2 days, P = .02). Positive surgical margin rates were 11% in the LRP and 4% in the ORP group ( P = .30). Continence (16 vs 19, P = .40) and erectile dysfunction rates (70% vs 74%, P = .84) in LRP and ORP groups were similar. At 1-year follow-up, serum prostate-specific antigen levels were found to be <0.01 ng/mL in 24 patients in the LRP and 26 patients in the ORP group. This study suggests that LRP can be initiated by a surgeon with prior laparoscopic experience in other surgeries and limited ORP experience, provided an experienced surgical team and a structured training background are available, with acceptable perioperative, functional, and short-term oncological outcomes.