Abstract：Objective: To investigate the operative points and clinical value of extraperitoneal laparoscopic radical resection of prostate cancer by three-hole method. Methods: The clinical data of 24 patients who underwent three-hole extraperitoneal laparoscopic radical prostatectomy in our hospital from January 2016 to June 2019 were retrospectively analyzed. The patients (aged 69.2±5.2 years, preoperative total prostate specific antigen 22.0±25.2 g/L) included 9 cases at ≤ 6 points, 11 cases at 7 points, 3 cases at 8 points, and 1 case in 9 points in preoperative Gleason score. The pneumoperitoneum was established by placing 10 mm, 5 mm and 10 mm cannula at 2 cm below the umbilicus and at the lateral margin of the right and left rectus abdominis through the outer peritoneal approach. The prostatectomy was performed, urethra and bladder neck were successively anastomosed with 3-0 5/8 arc barbed line, and then the anterior wall of the bladder neck was sutured and fixed with the deep vein complex of the penile dorsal. Postoperative follow-up was conducted to analyze the operative time, the intraoperative blood loss, the perioperative complications, the positive rate of specimen margin, the change of serum prostate-specific antigen (PSA) value, and the recovery time of urine control. Results: All 24 cases of extraperitoneal laparoscopic radical resection of prostate cancer by three-hole method were successful, and there was no convention to open surgery. The median operative time and median blood loss were (148.0±49.3) min and (156.8±158.9) mL, respectively, and no blood transfusion was performed intraoperatively and postoperatively. Postoperative surgical margins were positive in 3 patients. Twenty patients basically recovered from master urine control 3 months after the operation, and 24 patients recovered from autonomic urine control 6 months after the operation. At an average of 24 (6-48) months of postoperative follow-up, patients with positive surgical margins and those with medium-high risk of prostate cancer were treated with continuous endocrine therapy. Postoperative bladder calculi occurred in 1 case with lithotripsy, and as of press time, 2 patients had advanced castration-resistant prostate cancer. Conclusion: Three-hole extraperitoneal laparoscopic radical prostatectomy is safe and feasible for prostate cancer, but it is difficult to reveal the operative field of vision, which requires careful dissection.
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