Skip to main content
SpringerLink
Log in

Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy: a prospective assessment of patient scar satisfaction

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To compare patient scar satisfaction after retropubic, standard laparoscopic, mini-laparoscopic (ML) and open radical prostatectomy (RP).

Methods

Patients undergoing RP for a diagnosis of localized prostate cancer at a single academic hospital between September 2012 and December 2013 were enrolled in this prospective nonrandomized study. The patients were included in three study arms: open surgery, VLP and ML. A skin stapler was used for surgical wound closure in all cases. Demographic and main surgical outcomes, including perioperative complications, were analyzed. Surgical scar satisfaction was measured using the Patient and Observer Scar Assessment Questionnaire (POSAS) and the two Body Image Questionnaire (BIQ) scales, respectively, recorded at skin clips removal and either at 6 months after surgery.

Results

Overall, 32 patients were enrolled and completed the 6 month of follow-up. At clips removal, laparoscopic approaches offered better scar result than open surgery according to the POSAS. However, at 6 months, no differences were detected between VLP and open, whereas ML was still associated with a better scar outcome (p = 0.001). This finding was also confirmed by both BIQ scales, including the body image score (ML 9.8 ± 1.69, open 15.73 ± 3.47, VLP 13.27 ± 3.64; p = 0.001) and the cosmetic score (ML 16.6 ± 4.12, open 10 ± 1.9, LP 12.91 ± 3.59; p = 0.001). Small sample size and lack of randomization represent the main limitations of this study.

Conclusions

ML RP offers a better cosmetic outcome when compared to both open and standard laparoscopic RP, representing a step toward minimal surgical scar. The impact of scar outcome on RP patients’ quality of life remains to be determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N (2014) EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65:124–137

    Article  PubMed  Google Scholar 

  2. Mullins JK, Feng Z, Trock BJ, Epstein JI, Walsh PC, Loeb S (2012) The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol 188:2219–2224

    Article  PubMed  Google Scholar 

  3. Hruza M, Bermejo JL, Flinspach B, Schulze M, Teber D, Rumpelt HJ, Rassweiler JJ (2013) Long-term oncological outcomes after laparoscopic radical prostatectomy. BJU Int 111:271–280

    Article  PubMed  Google Scholar 

  4. Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR, Costello A, Eastham JA, Ficarra V, Guazzoni G, Menon M, Novara G, Patel VR, Stolzenburg JU, Van der Poel H, Van PH, Mottrie A (2012) Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 62:368–381

    Article  PubMed  Google Scholar 

  5. Autorino R, White WM, Gettman MT, Khalifeh A, De SM, Lima E, Kaouk JH (2012) Public perception of “scarless” surgery: a critical analysis of the literature. Urology 80:495–502

    Article  PubMed  Google Scholar 

  6. Pini G, Rassweiler J (2012) Minilaparoscopy and laparoendoscopic single-site surgery: mini- and single-scar in urology. Minim Invasive Ther Allied Technol 21:8–25

    Article  PubMed  Google Scholar 

  7. Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A et al (2014) Contemporary urologic minilaparoscopy: indications, techniques and surgical outcomes in a multi-institutional European cohort. J Endourol 28(8):951–957

  8. Fiori C, Morra I, Bertolo R, Mele F, Chiarissi ML, Porpiglia F (2013) Standard vs mini-laparoscopic pyeloplasty: perioperative outcomes and cosmetic results. BJU Int 111:E121–E126

    Article  PubMed  Google Scholar 

  9. Robertson C, Close A, Fraser C, Gurung T, Jia X, Sharma P, Vale L, Ramsay C, Pickard R (2013) Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: a systematic review and mixed treatment comparison meta-analysis. BJU Int 112:798–812

    Article  PubMed  Google Scholar 

  10. Moran PS, O’Neill M, Teljeur C, Flattery M, Murphy LA, Smyth G, Ryan M (2013) Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: a systematic review and meta-analysis. Int J Urol 20:312–321

    Article  PubMed  Google Scholar 

  11. Delongchamps NB, Belas O, Saighi D, Zerbib M, Peyromaure M (2013) Prospective comparison of scar-related satisfaction and quality of life after laparoscopic versus open radical prostatectomy: no differences from patients’ point of view. World J Urol 31:389–393

    Article  PubMed  Google Scholar 

  12. Walsh PC (1998) Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 160:2418–2424

    Article  CAS  PubMed  Google Scholar 

  13. Stolzenburg JU, Kallidonis P, Minh D, Dietel A, Hafner T, Dimitriou D, Al-Aown A, Kyriazis I, Liatsikos EN (2009) Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2400 cases. J Endourol 23:1467–1472

    Article  PubMed  Google Scholar 

  14. Kazaryan AM, Rosok BI, Edwin B (2013) Morbidity assessment in surgery: refinement proposal based on a concept of perioperative adverse events. ISRN Surg 2013:625093

    Article  PubMed Central  PubMed  Google Scholar 

  15. Durani P, McGrouther DA, Ferguson MW (2009) Current scales for assessing human scarring: a review. J Plast Reconstr Aesthet Surg 62:713–720

    Article  PubMed  Google Scholar 

  16. http://www.posas.org. Patient and Observer Scar Assessment Scale (2014)

  17. Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12:1334–1340

    Article  CAS  PubMed  Google Scholar 

  18. Olweny EO, Mir SA, Best SL, Park SK, Donnally IC, Cadeddu JA, Tracy CR (2012) Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery. BJU Int 110:268–272

    Article  PubMed  Google Scholar 

  19. Bucher P, Pugin F, Ostermann S, Ris F, Chilcott M, Morel P (2011) Population perception of surgical safety and body image trauma: a plea for scarless surgery ? Surg Endosc 25:408–415

    Article  PubMed  Google Scholar 

  20. Linares HA (1996) From wound to scar. Burns 22:339–352

    Article  CAS  PubMed  Google Scholar 

  21. Golkar FC, Ross SB, Sperry S, Vice M, Luberice K, Donn N, Morton C, Hernandez JM, Rosemurgy AS (2012) Patients’ perceptions of laparoendoscopic single-site surgery: the cosmetic effect. Am J Surg 204:751–761

    Article  PubMed  Google Scholar 

  22. Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J (2002) Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial. Surg Endosc 16:458–464

    Article  CAS  PubMed  Google Scholar 

  23. Novitsky YW, Kercher KW, Czerniach DR, Kaban GK, Khera S, Gallagher-Dorval KA, Callery MP, Litwin DE, Kelly JJ (2005) Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial. Arch Surg 140:1178–1183

    Article  PubMed  Google Scholar 

  24. Gurusamy KS, Samraj K, Ramamoorthy R, Farouk M, Fusai G, Davidson BR (2010) Miniport versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev CD006804

  25. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van PH (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55:1037–1063

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study was approved by our ethics committee and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Author information

Authors and Affiliations

  1. Department of Urology, University of Palermo, Palermo, Italy

    Carmelo Quattrone & Carlo Pavone

  2. Department of Urology, Magna Graecia University, Catanzaro, Italy

    Antonio Cicione, Francesco Cantiello & Rocco Damiano

  3. Department of Urology, Braga Hospital, Braga, Portugal

    Carlos Oliveira & Estevão Lima

  4. Urology Unit, Second University of Naples, Naples, Italy

    Riccardo Autorino & Marco De Sio

  5. Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA

    Riccardo Autorino

  6. Department of Urology, Federico II University, Naples, Italy

    Vincenzo Mirone

  7. Department of Economy and Law, University of Cassino and Southern Lazio, Cassino, Italy

    Luca Carrubbo

Authors
  1. Carmelo Quattrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Cicione
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Riccardo Autorino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Cantiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vincenzo Mirone
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco De Sio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luca Carrubbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rocco Damiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carlo Pavone
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Estevão Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riccardo Autorino.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Quattrone, C., Cicione, A., Oliveira, C. et al. Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy: a prospective assessment of patient scar satisfaction. World J Urol 33, 1181–1187 (2015). https://doi.org/10.1007/s00345-014-1425-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1425-z

Keywords

Search

Navigation