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

Purpose. To compare patient scar satisfaction after retropubic, standard laparoscopic (VLP), minilaparoscopic (ML) and open radical prostatectomy (RP). Methods. Patients undergoing RP for a diagnosis of localized prostate cancer between September 2012 and December 2013 were enrolled in this prospective nonrandomized study. The patients were included in three study arms: open 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 were measured using the Patient and Observer Scar Assessment Questionnaire (POSAS) the two Body Image Questionnaire (BIQ) scales, respectively recorded at skin clips removal and either at 6 months after surgery. Results. Overall, thirty two patient were enrolled and completed the six 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 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. MLRP offer a better cosmetic outcome when compared to both open and standard laparoscopic RP, representing a step towards minimal surgical scvar. The impact of scar outcome on RP patients' quality of life remains to be determined.