What is the predictor of prolonged operative time during laparoscopic radical prostatectomy?

Objectives: To study the impact of high body mass index and large prostate weight on operative time of laparoscopic radical prostatectomy. Methods: A retrospective analysis of medical records from patients who had undergone extraperitoneal laparoscopic radical prostatectomy by a single surgeon at our institution between September 2008 and April 2011 was carried out. For each case, the following parameters were recorded: age, body mass index, prostate weight, cross-section area of the Retzius space, and history of previous lower abdominal surgery, repeated prostate biopsy and neoadjuvant hormone therapy. The laparoscopic radical prostatectomy procedure was divided into seven surgical steps: (i) port insertion and lymph node dissection; (ii) endopelvic fascia incision; (iii) dorsal vein complex ligation; (iv) prostate dissection from bladder neck; (v) dissection of seminal vesicles and vas deferens; (vi) prostate dissection from rectum; and (vii) vesicourethral anastomosis. The overall operative time and the duration of each surgical step were retrieved. Potential predictors of prolonged total operative time and prolonged duration of a step were assessed by multivariate logistic regression analysis. Results: A total of 152 patients were analyzed. High body mass index (≥25.0kg/m²) and prostate weight were independent predictors of prolonged total operative time. High body mass index was an independent predictor of prolonged step1, 3, 4, 5 and 6. Prostate weight was an independent predictor of prolonged step2, 5 and 6. A history of previous lower abdominal surgery was a predictor of prolonged step1. Conclusions: High body mass index and high prostate weight are independent predictors of prolonged total operative time in extraperitoneal laparoscopic radical prostatectomy. Although high body mass index seems to affect most of the surgical steps of the procedure, prostate weight mainly impacts the dissection close to the prostate, as enlarged prostate results in a narrower working space.