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Laparoscopic Urologic Surgery in Malignancies

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The era of endo-oncology has arrived. Endo-oncology is now firmly en- trenched in the diagnosis and management of urologic cancers. From its early days with transurethral resection of bladder tumors, to the more recent de- cades with establishment of techniques for percutaneous resection of transi- tional cell carcinoma, endo-oncology is the endoscopic treatment of cancer. More recendy, the application of laparoscopy to the treatment of urologic can- cers has continued the tradition. Laparoscopy has expanded and evolved from a diagnostic modality with laparoscopic pelvic lymphadenectomy for prostate cancer to include radical therapy for surgical management of every abdominal organ in the genitourinary system.

This textbook is important for many reasons. The integration of oncologic therapeutic intervention with a minimally invasive modality must bear the scrutiny of direct comparison with open surgery in terms of actuarial survival statistics and functional results. Laparoscopic radical nephrectomy for renal cell carcinoma has withstood the test of time in terms of disease-free survival, blood loss, postoperative discomfort, tumor port site implantation, hospital stay and convalescence. For other procedures, we look to achieve the same standards.

The advance of laparoscopy into the realm of oncologic surgery has also challenged individuals who perform open surgery to re-examine their practice in order to improve their functional results. The challenge to improve the morbidity of any procedure is to the ultimate benefit of our patients.

Just as there are multiple ways to cook in the kitchen, there are numerous techniques for laparoscopic radical prostatectomy. From a transperitoneal approach to an extraperitoneal approach, to subde changes in addressing the seminal vesicles and vas deferens, vesical-urethral anastomosis or port place- ment, the optimal method continues to evolve. Significantly less blood loss and earlier achievement of urinary continence are proven benefits of this pro- cedure. With the learning curve, recognition of earlier difficulties have led to modifications that are reducing margin-positive rates to the standards set by open radical retropubic prostatectomy. We look forward to reviewing long- term of PSA follow-up and survival statistics with which vigilant surveillance will prove the true efficacy of this procedure.
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