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Cryosurgical ablation of the prostate has resurfaced as a potential treatment option for organ-confined adenocarcinoma of the prostate. This study examines the temperatures achieved at the anterior prostatic capsule during the freeze-thaw cycle of transperineal cryosurgical ablation of the prostate. Additionally, as there was direct laparoscopic visualization of the prostate, frost forming outside the prostate would have been detected. Two patients underwent endoscopic extraperitoneal pelvic lymphadenectomy followed, with patients under the same anesthetic, by transperineal cryosurgical ablation of the prostate. Nadir prostatic capsular temperatures reached - 28 and - 36 degrees C, respectively, occurring approximately 13 min into the freezing phase. At these temperatures, no frost was observed endoscopically at the ventral surface of the prostate. Ice was palpated with endoscopic probes several millimeters below the ventral capsular surface. These nadir temperatures are lower than those of previous studies on cryosurgical ablation of the human prostate. Further studies need to examine the temperatures required to produce cell death and to determine whether periprostatic tissues can be treated safely and effectively for locally advanced disease.

Fifty-four patients underwent staging laparoscopic pelvic lymphadenectomy under general anesthesia for prostatic carcinoma (49), bladder carcinoma (3), penile carcinoma (1), and lymphoma (1). Conversion to an open procedure occurred only once in the series, but three patients received secondary open operations (5.5%). Complications recognized intraoperatively included bladder perforation (2) and mesenteric hematoma (1). One bladder perforation was repaired laparoscopically. The other was treated with catheter drainage. The mesenteric hematoma was explored surgically and found to be minor. Major postoperative complications included bleeding (4) requiring transfusion in two patients. One hematoma became infected requiring percutaneous drainage. One patient required intubation due to chronic obstructive pulmonary disease (COPD). Ureteral injury (1) was recognized late and required a psoas hitch and ureteroneocystostomy. Two patients developed small bowel obstructions due to herniation through a trocar site, requiring operative correction. Minor postoperative complications included ileus (4), diarrhea (2), bronchospasm (1), transient obturator nerve palsy (1), electrocardiogram changes (1), and fever (1). The overall major complication rate was 16.7%, and the overall minor complication rate was 18.4%. In this series, a substantial learning curve was seen with regard to complications, but the series compared favorably with open lymphadenectomy.