Evaluation of Three-Dimensional Laparoscopic Prostatectomy in the Treatment of Prostate Cancer

The aim of this study was to evaluate the role of 3D laparoscopic prostatectomy (3D LRP) as a surgical method in the treatment of prostate cancer (PCa). We aimed to investigate how the surgical method can be learned and how it can be implemented in different centers where there is no previous experience with the method. In the world's first randomized trial, the goal was to determine how 3D LRP compares to robot-assisted laparoscopic prostatectomy (RALP). In the evaluation the functional results after surgery, we aimed to assess the usability of the Visual analogue scale (VAS) compared to the validated EPIC-26 questionnaire.

The first study of this dissertation investigated the learning curve (LC) of the operating surgeon and the surgeon's development using data from 200 patients. The study also evaluated perioperative, oncological, and functional results. The development could be observed as an improvement in anastomosis and total operating time (TOT), for which a plateau phase was reached in 30 and 60 patients, respectively. Perioperative, oncological, and functional results were comparable to previous literature seen with RALP.

In the second study, we examined the surgical results of 3D LRP in four different central hospitals and compared the perioperative, functional, and oncological results with those in the previous literature. The results observed in the study were comparable to previous studies conducted with RALP in Finland and the Nordic countries. In the randomized study, we compared in a prospective study setting 3D LRP to RALP as a method for treating PCa. The primary outcome was urinary continence one year after the surgery, as assessed by the EPIC-26 incontinence section score. The secondary outcomes were the use of protective pads, other sections of the EPIC-26 questionnaire, oncological results, and surgical complications. No statistically significant difference between surgical methods were observed in the study. The fourth study investigated the usability of the VAS compared to the EPIC-26 questionnaire in assessing urinary continence and erectile ability in patients who had undergone 3D LRP. The study found a strong correlation between the sections measuring urinary incontinence and erectile ability in EPIC-26 and the corresponding VAS.

The findings show that 3D LRP is quicker to learn than 2D laparoscopic prostatectomy (2D LRP), which is considered difficult and a method with LC comparable to RALP. The perioperative, oncological, and functional results are comparable to studies described in the Nordic countries and in Finland with RALP. For the treatment of medium- or high-risk prostate cancer, 3D LRP is a comparable alternative to RALP. The VAS is a useful tool for evaluating functional surgical results after 3D laparoscopic prostatectomy.