Laparoscopic radical prostatectomy

What is laparoscopic radical prostatectomy?

Laparoscopic radical prostatectomy is the technique that allows an oncologically safe extirpation of the prostatic gland in the case of a prostate cancer.

It is achieved by means of 4 or 5 accesses (trocars). The procedure consists on the separation of the prostate from its neighboring organs (urinary bladder and urethra) to allow its extirpation. Afterwards, a reconstruction of the urinary tract is needed, connecting the bladder to the urethra. This anastomosis requires a master grip onlaparoscopic suturing technique to be perfectly watertight.

Bipolar electric energy and haemostatic clips are usually used for bleeding control. The procedure may be done through the peritoneal cavity (abdominal cavity) or through an extraperitoneal approach. The initial technique was described through an intrabdominal way, with plenty space and easy orientation references although there is a tendency nowadays in favoring the extraperitoneal approach. This last approach is faster (reducing surgical time), offers a tighter working space (that may difficult some maneuvers) and does not invade the abdominal cavity (avoiding the risks that this may suppose).

When it is feasible, neurovascular bundles, responsible for normal erection, may be preserved, obtaining better results in its recovering.

Usual surgical time length is about two hours. In the postoperative period a bladder catheter is maintained usually for one week.

What are the advantages of laparoscopic radical prostatectomy?

The main advantage is the surgical view. Image magnification allows for much finer and precise surgical moves, facts of great importance in oncological surgery.

The laparoscopic approach avoids big incisions, reason why normal life recovering is very quick. Surgical timing is longer than with the classical approach but that reverts in shorter hospital stay. Surgical bleeding tends to be minimum, making blood transfusion not needed.

When can the erection nerves be preserved?

Erection loss is one of the handicaps of prostate cancer treatment. Depending on the particular case, one or both neurovascular bundles may be preserved with a higher chance (approximately 50%) of erection recovering.

Laparoscopic surgery, thanks to the magnification view, allows for a precise dissection of theses bundles whenever possible. Main treatment intention though is disease cure, being in a second term the functional deficits that the treatment may cause. This is the reason why each case must be carefully evaluated before and during the surgical procedure. In front of doubt of a correct surgical procedure from an oncological point of view, neurovascular bundles are sacrificed.

In which cases can urinary continence be affected?

Almost all patients after a laparoscopic radical prostatectomy experience some urine control difficulty. Most of them present with stress urinary leakage that resolves gradually in weeks’ time. A small proportion of patients (less than 5%) may have trouble in achieving a perfect urine control in the long term.

The fact of urinary continence affection is not only related to the type of surgical technique but also of the urinary sphincter anatomy. That is why all techniques of prostate extirpation may injury the sphincter. The laparoscopic approach tries to minimize that risk preserving the longest urethral stump possible.

Few cases may develop urinary retention trouble once the bladder catheter is pulled out due to inflammation of the suture site that recovers in a days’ period.