Prostate Removal Surgery

The word "laparoscopy" means to look inside the abdomen with a special camera or scope. Surgery performed with the aid of these cameras is known as "keyhole," "porthole," or "minimally invasive" surgery.

Traditional surgery requires a long incision (cut) down the center of the abdomen and a lengthy recovery period. Laparoscopic surgery eliminates the need for this large incision. As a result, you may experience less pain and scarring after surgery, more rapid recovery, and less risk of infection.

For laparoscopic prostate surgery, this technique requires five small (5-10 millimeters) incisions (or "portholes") -- one just below the belly button 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 belly button. This gas lifts the abdominal wall to give the surgeon a better view of the abdominal cavity once the laparoscope is in place. The surgeon is then guided by the laparoscope, which transmits a picture of the prostate onto a video monitor.

Laparoscopy is a relatively new technique for prostate removal, but it looks promising. Men who undergo this technique have less blood loss, less need for pain medicine, shorter hospital stays, quicker return to regular diet and activities, early removal of urethral catheters (tubes inserted through the penis to drain urine from the bladder), and a quicker recovery. Laparoscopy also appears to treat the cancer as well as conventional "open" procedures that are performed with a large incision.

What are the advantages of laparoscopy?
As is the case with other minimally invasive procedures, laparoscopic prostate removal has significant advantages over traditional "open" surgery:

Laparoscopy can shorten your hospital stay to one or two days. About 50 percent of men are discharged one day after surgery. (The length of stay depends on how quickly you recover and the extent of the surgery.)
There is significantly less bleeding during the operation.
You are less likely to need prescription painkillers after you leave the hospital. Patients generally need nothing more than Tylenol.
At your follow-up appointment one week after surgery, the tube — or catheter — draining your bladder will be removed if there are no signs of other problems. Occasionally, the catheter must remain in place for another week, as is routinely the case following conventional "open" surgery.
About 90 percent of patients can return to work or resume full activity in only two to three weeks.
Am I eligible for this surgery?
You are eligible if you have cancer that has not spread outside the prostate and is not very aggressive, as well as a PSA blood test less than 10. You are not eligible if you have had previous open or laparoscopic pelvic surgery, even for another reason, or a history of hormone treatment called LH-RH agonist (luteinizing hormone-releasing hormone), which reduces the size of the prostate tumor.

What are the side effects?
Medical research so far has shown the frequency of incontinence and impotence to be similar between minimally invasive surgery and open surgery -- with men usually returning to normal urinary function within three months for both types of surgeries. Both types of surgeries also have similar rates of incontinence.

Because this technique is nerve-sparing, postoperative sexual potency rate should be comparable to that of conventional open surgery. However, it is important to note that minimally invasive prostate surgery has not been in use long enough to truly assess whether or not it leads to higher rates of potency. But early results are promising.

How do I prepare for surgery?
Your surgeon will meet with you to answer any questions you might have. You will be asked questions about your health history, and a general physical examination will be performed. If your intestine requires cleaning, you will be given a prescription for a laxative medicine to take the evening before the surgery.

All patients are generally asked to provide a blood sample. Depending on your age and general health, you might also have an EKG (electrocardiogram), a chest X-ray, lung function tests, or other tests.

Finally, you will meet with an anesthesiologist who will discuss the type of anesthesia you will be given for surgery. You will also learn about pain control after the operation, which might include a PCA (patient controlled analgesia) pump.

What happens during surgery?
Your surgeon will place a small needle just below your belly button and insert the needle into your abdominal cavity. The needle is connected to a small tube, and carbon dioxide is passed into the abdominal cavity. This gas lifts the abdominal wall to give the surgeon a better view of the abdominal cavity once the laparoscope is in place. The surgeon is then guided by the laparoscope, which transmits a picture of the prostate onto a video monitor.

Next, a small incision will be made near your belly button. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.

Before starting the surgery, the surgeon will take a thorough look at your abdominal cavity to make sure the laparoscopy procedure will be safe for you. If the surgeon determines that the procedure will not be safe for you because of the presence of scar tissue, infection ,or abdominal disease, the procedure will not be continued.

If the surgeon decides the surgery can be safely performed, additional small incisions will be made, giving your surgeon access to the abdominal cavity. If necessary, one of these small incisions might be enlarged to remove the pelvic lymph nodes.

What happens after surgery?
You can expect to follow a liquid diet and you gradually will be able to eat solid foods. When you go home, you will follow a soft diet, which generally means no raw fruits or vegetables. A dietitian can provide more specific dietary guidelines.

Nausea and vomiting are common and occur because the intestines are temporarily disabled during anesthesia and surgery. Your doctor can prescribe medicines to relieve these symptoms, which will improve a few days after surgery.

You will be encouraged to get out of bed and walk as much as possible, starting the first day after surgery. You should steadily increase your activity after you go home. For six weeks after surgery, you should not lift or push anything over 30 pounds, and do not do abdominal exercises such as sit-ups.

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