Evangelos Liatsikos

Publications (48)123.3 Total impact

• Article: Treatment of patients after failed high intensity focused ultrasound and radiotherapy for localized prostate cancer: salvage laparoscopic extraperitoneal radical prostatectomy.

  Evangelos Liatsikos, Bernard Bynens, Robert Rabenalt, Panagiotis Kallidonis, Minh Do, Jens-Uwe Stolzenburg
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  ABSTRACT: To evaluate the feasibility and efficacy of salvage endoscopic extraperitoneal radical prostatectomy (EERPE) in recurrent prostate cancer after failed high intensity focused ultrasound therapy (HIFU), external beam radiotherapy (EBT) and brachytherapy. Twelve patients with mean age 63.3 years (48-74), mean preoperative PSA 12.7 ng/ml and mean prostate weight 48.8 grams were treated with salvage EERPE with curative intent for biopsy proven locally recurrent prostate cancer. Our group was consisted of four patients who have been treated in the past with HIFU, six with EBT and two with brachytherapy. Operative time, estimated blood loss, conversion to open surgery rate, transfusion rate and transurethral catheter time were recorded. Also functional outcome and short term oncological outcome were reviewed. Average operative time was 153 minutes. Mean blood loss was 238 ml. The procedure was completed in all cases with no difficulty and without intraoperative complications. There was no need for conversion to open surgery or transfusion. Mean total urethral catheterization time was 7.2 days. After mean follow-up of 20 months, 10 patients were completely continent, and 2 needed 1-2 pads per day. Three patients were potent before the surgical treatment, but no one reported potency postoperatively. Biochemical recurrence was observed in only one patient 12 months postoperatively. In the initial experience, salvage EERPE in experienced hands has minimal perioperative morbidity. Short term oncological and functional outcomes are encouraging but further studies and longer follow-up are required in order to assess the long-term outcomes.
  Journal of endourology / Endourological Society 11/2008; 22(10):2295-8. · 1.75 Impact Factor
• Article: Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy.

  Evangelos Liatsikos, Robert Rabenalt, Martin Burchardt, Miguel-Ramirez Backhaus, Minh Do, Anja Dietel, Johanna Wasserscheid, Costantinos Constantinides, Panagiotis Kallidonis, Michael C Truss, Thomas R Herrmann, Roman Ganzer, Jens-Uwe Stolzenburg
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  ABSTRACT: Laparoscopic transperitoneal radical prostatectomy (LRP) and endoscopic extraperitoneal radical prostatectomy (EERPE) are established techniques for the management of localized prostate cancer in numerous specialized urologic centers worldwide. The complication rates of LRP and EERPE are ranging between 2 and 17%. Rare but possible complications are vascular injuries, bowel injury, lymphocele formation, port-site hernia, anastomotic leakage, gas embolism and catheter obstruction and other rare events. Prevention and management of complications requires high surgical expertise and adequate standardization of the technique. We herein review our experience with the endoscopic extraperitoneal radical prostatectomy in a series of 1,800 consecutive patients regarding the appearance of complications and their management.
  World Journal of Urology 10/2008; 26(6):571-80. · 2.41 Impact Factor
• Article: Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration.

  Jens-Uwe Stolzenburg, Johanna Wasserscheid, Robert Rabenalt, Minh Do, Thilo Schwalenberg, Alan McNeill, Costantinos Constantinides, Panagiotis Kallidonis, Roman Ganzer, Evangelos Liatsikos
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  ABSTRACT: In our series of 1,900 endoscopic extraperitoneal radical prostatectomies (EERPE) the incidence of symptomatic lymphocele following simultaneous pelvic lymph node dissection (PLND) is between 3 and 14% depending on the extent of lymph node dissection. We report the impact of bilateral peritoneal fenestration after completion of extraperitoneal prostatectomy and PLND on the incidence of lymphocele, postoperative pain and complications. A total of 100 consecutive patients undergoing EERPE and extended PLND were allocated into two groups. In Group A (n = 50) a 4-6 cm incision was performed bilaterally over the external iliac vessels down to the obturator fossa after completion of the main procedure. In Group B (n = 50) no peritoneal incisions were made. The postoperative assessment protocol included a visual analogue pain scale administered three times daily for 6 days, analgesia requirement, and ultrasound examination on 4th and 8th days, and 3 months postoperatively. CRP and leucocyte counts were measured on 1st and 2nd postoperative days. Complications were recorded according to our standard protocol using the Clavien classification. Three patients (6%) in Group A were found to have lymphoceles, none of which were symptomatic. Significantly more patients in Group B developed a lymphocele, (n = 16, 32%, P < 0.001) of which a significant number were symptomatic (n = 7, 14%, P < 0.001) and required laparoscopic fenestration. No significant difference was observed between the pain score in either group. Mean pain scores were 3.4 versus 3.8 at 6 h, and 0.8 versus 1.1 at 6 days, respectively. No difference in analgesia requirement, serum inflammatory markers and return to normal bowel activity was observed between the groups. This study demonstrates that peritoneal fenestration significantly reduces the incidence of both symptomatic and asymptomatic lymphocele, without an increase in postoperative morbidity. As symptomatic lymphocele is one of the most common complications of extraperitoneal PLND requiring reintervention, we recommend that peritoneal fenestration should be performed routinely after extraperitoneal radical prostatectomy and PLND.
  World Journal of Urology 09/2008; 26(6):581-6. · 2.41 Impact Factor
• Source

  Available from: Mathias Winkler

  Article: Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy.

  Jens-Uwe Stolzenburg, Robert Rabenalt, Minh Do, Thilo Schwalenberg, Mathias Winkler, Anja Dietel, Evangelos Liatsikos
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  ABSTRACT: Based on our recently published anatomic studies, we present the most recent refinement of the endoscopic extraperitoneal radical prostatectomy (EERPE), the intrafascial nerve-sparing EERPE (nsEERPE). As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule, freeing the prostate laterally from its thin surrounding fascia that contains small vessels and nerves. The technique enables puboprostatic ligament preservation, leaving intact endopelvic fascia, periprostatic fascia, and neurovascular bundles. The operation was performed in 150 patients with indications for nerve-sparing procedure. The mean operative time was 131 min (range: 50-210 min) and the mean catheterization time was 5.9 d (range: 4-20 d). Twelve months postoperatively, 94.3% of the patients were continent (no need for pads), 4.6% had minimal stress incontinence, and one patient required >2 pads/d. At the 12-mo follow-up, the potency rates (erections sufficient for intercourse with or without the use of phosphodiesterase 5 [PDE5] inhibitors) of the patients who underwent bilateral intrafascial nsEERPE were 89.7% (age: 44-55 yr), 81.1% (age: 56-65 yr), and 61.9% (age: >65 yr). Positive surgical margins in pT2 and pT3 tumors were 4.5% and 29.4%, respectively. The intrafascial nsEERPE enables the dissection of the prostate with limited trauma to the surrounding fascias and the enclosed neurovascular bundles. We propose that the preserved neurovascular bundles with intrafascial nsEERPE are more viable. The results advocate this proposition.
  European Urology 05/2008; 53(5):931-40. · 8.49 Impact Factor
• Article: Performance and functional outcome of endoscopic extraperitoneal radical prostatectomy in relation to obesity: an assessment of 500 patients.

  Evangelos Liatsikos, Sandra Mühlstädt, Panagiotis Kallidonis, Robert Rabenalt, Minh Do, Martin Burchardt, Thomas R Herrmann, Jens-Uwe Stolzenburg
  [show abstract] [hide abstract]
  ABSTRACT: To investigate the impact of obesity on the performance and functional outcome of endoscopic extraperitoneal radical prostatectomy (EERPE). We retrospectively examined 500 patients treated with EERPE; they were categorized into three groups according to the World Health Organization classification of obesity: normal weight (body mass index, BMI, <25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obese (30.0 kg/m(2)). The database of our institution was reviewed and perioperative data evaluated. The functional data were collected through questionnaires before and after EERPE and analysed statistically. The age, prostate size and preoperative PSA level were similar in all three groups. The mean (sd) BMI was 27 (3.3) kg/m(2), with 26.8%, 56.6% and 16.6% of the patients classed as normal, overweight and obese, respectively. A pelvic lymph node dissection and nerve-sparing was done in 218 and 123 patients, respectively. There was no statistically significance difference in the number of patients in each group who had previous procedures. Obese patients had a significantly higher American Society of Anesthesiologists score. The mean operative duration for all patients was 149 min; there was a statistically significant difference in duration among the three groups, with EERPE or nerve-sparing EERPE requiring a mean of 20 min more in obese patients. There was no conversion to open surgery. The estimated mean blood loss was 200 mL; four patients, none of them in the obese group, received a blood transfusion. At 3 months after EERPE there was a trend to worse continence in obese patients, but it was not statistically significant, and was not apparent at 6 months. There was no difference in transfusion rate and duration of catheterization. EERPE seems to be a feasible and reproducible surgical technique in obese patients, although the operation takes longer.
  BJU International 04/2008; 102(6):718-22. · 2.84 Impact Factor
• Article: Salvage laparoscopic extraperitoneal radical prostatectomy after failed high-intensity focused ultrasound and radiotherapy for localized prostate cancer.

  Jens-Uwe Stolzenburg, Bernard Bynens, Minh Do, Robert Rabenalt, Paraskevi F Katsakiori, Evangelos Liatsikos
  [show abstract] [hide abstract]
  ABSTRACT: To investigate the feasibility and efficacy of salvage endoscopic extraperitoneal radical prostatectomy (EERPE) in cases of recurrent prostate cancer after high-intensity focused ultrasound therapy (HIFU) or radiotherapy. Nine patients underwent salvage EERPE with curative intent for biopsy-proven, locally recurrent prostate cancer. Of these 9 patients, 3 had previously undergone HIFU and 6 radiotherapy. Perioperative parameters (operation time, estimated blood loss, conversion to open surgery rate, transfusion rate, transurethral catheter time), functional outcome, and short-term oncologic outcome were reviewed. Mean patient age was 63.3 years (range 48 to 74 years). Mean preoperative PSA value was 12.64 ng/mL and mean prostate weight was 49.2 g. Mean blood loss was 238 mL. There was no need for conversion to open surgery or transfusion. Mean operation time was 148 minutes, and mean total transurethral catheter time was 6 days. No intraoperative complications were reported. There was no clear difference in operation difficulty between the post-HIFU and postradiotherapy EERPE. After a mean follow-up of 17 months, 7 patients were completely continent, and 2 needed 1 to 2 pads per day. Three patients were potent before the surgical treatment, but no patient reported potency postoperatively. In 1 patient a PSA relapse (1.20 ng/mL) was recognized 12 months postoperatively. Salvage EERPE after failed HIFU and radiation therapy is a safe and efficient method to treat locally recurrent prostate cancer. Short-term oncologic and functional outcomes are promising, but further study should be made on the long-term oncologic outcomes of this technique.
  Urology 12/2007; 70(5):956-60. · 2.43 Impact Factor
• Chapter: Percutaneous Nephrolithotomy and Percutaneous Nephrostomy

  Jens-Uwe Stolzenburg, Chris Anderson, Evangelos Liatsikos, Thilo Schwalenberg, Rudolf Hohenfellner
  12/2005: pages 93-103;
• Source

  Available from: eu-acme.org

  Article: Training in Laparoscopy

  Jens-Uwe Stolzenburg, Michael C. Truss, Robert Rabenalt, Minh Do, Thilo Schwalenberg, Paraskevi F. Katsakiori, Alan McNeill, Evangelos Liatsikos
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  ABSTRACT: ObjectiveTraining in laparoscopy is still a challenge for the urologic community. Surgeons in training must learn the laparoscopic techniques, possibly without having ever performed the conventional procedure. In the present study, we provide a nonstructured literature review pertaining to laparoscopic training and discuss the training design and the modular concept.MethodsA thorough literature search was performed with the Medline database and different training procedures were analysed.ResultsDue to increasing time constraints, cost, stress, and ethical considerations, the modern operating room is not the ideal learning environment. Various simulators and models for laparoscopic training in urology and general surgery with different levels of validity and reliability are available. Wide acceptance of the use simulators has been hampered by the lack of standard and valid methods to measure and certify competence in basic psychomotor skills. Besides, it is unclear if trainees have enough access to these programmes and if they are sufficient enough to develop the required skills. Whether complex urologic procedures can be performed by beginners without open surgical expertise and whether experience in open surgery is definitely required before mastering laparoscopic techniques are still matters of issue.ConclusionThe lack of a standardised, evaluated training procedure needs to be overcome. Structured training programmes and transference of gained experience into daily practice are essential to provide urology with expert laparoscopists.
  EAU-EBU Update Series.