Laparoscopic prostatectomy’s role in treating prostate cancer

Men who are diagnosed with localized prostate cancer or where the cancer is completely contained within the prostate gland and has not spread, have the option of being treated with a procedure called laparoscopic prostatectomy.  This procedure is a minimally invasive surgery that is conducted in order to remove a man’s prostate that has cancer. 

In the past before laparoscopic prostatectomy, men with localized prostate cancer had to undergo traditional open surgery.  This type of surgery is where a long incision is made for the surgeon to insert the instruments, visualizing the surgery through the incision.  Surgeons who perform laparoscopic prostatectomy on localized prostate cancer will not have to make a large incision but rather they make five small incisions in order to remove the entire prostate.

Any man who has localized prostate cancer is a candidate for laparoscopic prostatectomy.  This is also true for any man who is a candidate for open surgery who would have an excellent outcome with laparoscopic prostatectomy.

Advantages of laparoscopic prostatectomy

·      Less abdominal trauma

·      Shortened hospital stay

·      Better cosmetic outcomes

·      Significantly less bleeding

·      Early removal of catheter

·      Minimal requirement for pain medications after the surgery

·      10-15 times visual magnification

·      Resumption of normal activity within one to two week after surgery

Length of surgery

The surgery takes anywhere from 2 ½ to 3 ½ hours depending on the size of the prostate and each man’s individual anatomy.  This time length is comparable to traditional open surgery.

Each man is placed under general anesthesia to sleep for the duration of the surgery.  Then the surgeon makes small incisions to be able to insert surgical instruments and a camera.  The prostate gland will be removed along with the seminal vesicles which are two small fluid-filled sacs next to the prostate.  The urethra will be reattached to a part of the bladder called the bladder neck.  Depending on the patient, the surgeon may also remove surrounding lymph nodes for biopsy to check to make sure the cancer hasn’t spread.

Fortunately, blood loss is minimal of only about 150cc making the need for a blood transfusion very low.   

Length of hospital stay

Most patients can be discharged one day after laparoscopic prostatectomy but each man’s stay depends on how well the procedure went and how well a man is doing.  Over 90 percent of patients are able to go back home by the second night.

How long is a catheter kept in?

In traditional open surgery, the catheter is kept in for up to two to three weeks.  With laparoscopic prostatectomy, by the seventh day the catheter is removed. 

How does laparoscopic prostatectomy affect sexual functioning?

Because of the strong magnification the surgeon has access to during the procedure, it is much easier to save and spare the nerves responsible for sexual functioning.  It can take up to six months for a man to be able to regain complete sexual functioning.  If it has not returned by that time, a man may need to resort to taking Viagra which has significantly helped.

Will a man experience incontinence after surgery?

All men will need to wear a protective pad for the first few weeks after surgery.  Within a few weeks, up to 95 percent of men will have a return of continence with full control of their urination.  Kegel exercises are recommended for any man who is experiencing mild stress urinary incontinence after the procedure.