731 JOURNAL OF ENDOUROLOGY Volume 18, Number 8, October 2004 © Mary Ann Liebert, Inc. Third Prize Laparoscopic Radical Prostatectomy: Is Intact Organ Removal Attainable? Study of Margin Status DANNY M. RABAH, M.D., 1 PAUL F. SCHELLHAMMER, M.D., 1 JOSE I. DIAZ, M.D., 2 INGOLF TUERK, M.D., Ph.D., 3 DOUGLAS W. SODERDAHL, M.D., 1 and MICHAEL D. FABRIZIO, M.D. 1 ABSTRACT Purpose: To determine the initial oncologic results (pathology) of specimens removed by laparoscopic radical prostatectomy (LRP) by examining the surgical margins. Patients and Methods: The 70 consecutive LRP procedures performed for clinically localized prostate can- cer at Eastern Virginia Medical School from April 2001 to November 2002 were reviewed for preoperative and important intraoperative variables. The initial histopathology report and a prospective review by a sin- gle genitourinary pathologist for margin status as well parenchymal exposure of benign glands were assessed. Postoperative prostate specific antigen (PSA) levels were noted. Results: The clinical stage distribution was as follows: T1 c  59, T2 a  10, and T2 b  1. The preoperative median PSA value was 6.96 ng/mL. The mean operative time was 307 minutes. The mean estimated blood loss was 298 mL. The prospective pathologic review results were as follows: 1 pT 0 (1.4%), 60 pT 2 (85.7%), and 9 pT 3 (12.8%). The overall positive surgical-margin rate was 15.7%. Of those patients with pT2 disease; 8 specimens (13.3%) had a positive margin, whereas 33% of patients with pT 3 disease had a positive surgi- cal margin. Parenchymal exposure of benign glands on the inked surface was recognized in 8 patients (13.3%). Data from PSA assays 1 month postoperatively were available in 69 patients. Serum PSA was undetectable (0.1 ng/mL) in 67 men (97%). Conclusion: An LRP can offer surgical margins comparable to those of open procedures series reported in the literature. Long-term progression and survival outcome data are necessary before this procedure should be offered as a replacement for open prostatectomy. INTRODUCTION T HE GROWING APPEAL of minimally invasive surgery has prompted urologists to adapt these techniques for var- ious procedures. Such operations are gradually becoming the standard of care for such operations as live donor nephrec- tomies, radical nephrectomies, and pyeloplasties. Radical retropubic prostatectomy (RRP) and perineal prostatectomy (PP) are established approaches for the surgical removal of the malignant prostate. Laparoscopic radical prostatectomy (LRP) is a new operative procedure that must be compared with the standard approach before it is widely applied. Intraoperative and postoperative data are essential to making these compar- isons. 1 Intact surgical removal by assessment of margin status addresses the critical issue of cancer control. The steep learn- ing curve is also a practical resource-centered issue. The Euro- pean experience with LRP has demonstrated promising results. Certainly, to have any parity with RRP, the laparoscopic ap- proach must be successful in removing the entire prostate with- out capsular intrusion. The inability to grasp the organ manu- ally and the necessity of working without tactile feedback might intuitively appear to be disadvantages of the procedure. How- Departments of 1 Urology and 2 Pathology, Eastern Virginia Medical School, Norfolk, Virginia. 3 Charitè University, Berlin, Germany.