Laparoscopic Prostatectomy

A radical prostatectomy is the surgical removal of the entire prostate gland.  Many experts tend to recommend surgery when the cancer is thought to be contained within the prostate, such as in stage T1 and T2 cancers, and when the man is relatively young and healthy.  During surgery, the entire prostate gland plus some surrounding tissue is removed.  The surgery is almost always performed under general anesthesia. It is important to note that the experience and skill of the surgeon can be a major factor in the success of the surgery.  This is true in all surgical procedures, but is particularly true with a radical prostatectomy because of the challenging location of the prostate and the critical anatomy near the prostate.

This is a one-time procedure that in most cases effectively removes organ-confined, early-stage prostate cancer. Many surgeons believe that a radical prostatectomy is the best means of removing all prostate cancer from the body in early-stage cancer.  

The Prostatectomy is a major operation and requires hospitalization. The procedure can also produce significant side effects that may affect quality of life.  These include impotence and urinary incontinence (inability to control urination).  The risk of impotence depends on a number of factors including whether the surgeon leaves the nerves intact that control erection, the surgeon’s skill, the extent of the disease, the patient's age and erectile function before surgery.  The chance of impotence can also be reduced with the use of "nerve-sparing" surgery techniques.

Urinary incontinence occurs in only a small percentage of patients. Further, rarer complications that can occur with any major operation include life-threatening blood loss during surgery, blood clots in the leg or pelvic veins, heart attack and wound infection.

Two main types of prostate surgery are performed today: 1) radical retropubic prostatectomy, and 2) radical laparoscopic prostatectomy.  Each has its own advantages and disadvantages.

Radical Retropubic Prostatectomy (RRP)  
This is the method most often used to remove the prostate. An incision from the navel to the pubic bone is made in the lower abdomen.  During the operation, some surgeons will try to avoid removing two sets of nerves that are connected to either side of the prostate and that control erections.   However, if the cancer is growing into these nerves, then the surgeon will have to remove them.  This approach to radical prostatectomy allows lymph nodes to be removed to determine if the cancer has spread to the lymph nodes.

Laparoscopic Surgery
This technique involves five small (5-10 millimeter) incisions, one just below the navel and two each on both sides of the lower abdomen.  Carbon dioxide is passed into the abdominal cavity through a small tube placed into the incision below the navel to aid visualization.  The surgeon then guides the laparoscope, which transmits a picture of the prostate onto a video monitor.  This technique is relatively new for removing the prostate.

Men who undergo this laparoscopic surgery have less blood loss, less pain, shorter hospital stay, quicker return to regular diet and activities, early removal of catheters, and a quicker recovery.  Because this is a newer technique, it is especially important to understand the experience level of your particular surgeon.

Robotic Radical Laparoscopic Prostatectomy
The daVinci® Prostatectomy incorporates a robotic technique to facilitate a radical laparoscopic prostatectomy.  It provides a three-dimensional visualization with 10 times magnification of the critical structures surrounding the prostate to the surgeon and allows for more accurate surgical cuts.  Maximum surgical dexterity and precision is optimized through a full range of motion of its robotic arms and the surgeon is aided in performing several critical but repetitive steps during the surgery.    

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© 2005-2008 Dr. Lee Jackson   All rights reserved.             Ventura Group  Ft. Lauderdale, Florida