Laparoscopic Radical Prostatectomy
This is a type of keyhole surgery used for prostate cancer treatments to remove the prostate gland and the seminal vesicles as a treatment option for prostate cancer.
Traditionally radical prostatectomy was performed through a single incision that extended from the pubic bone to just below the umbilicus (belly button). This is not the case for LRP which uses instead, 5 small incisions through which ports or small tubes are placed. Specialized instruments and telescopic cameras are then inserted through the ports to perform the surgery in a precise manner facilitated by magnified vision.
In certain men a nerve sparing approach can be used. The nerves that are spared are the nerves that supply the erectile tissue within the penis. The aim of this type of surgery is firstly to cure the man of prostate cancer but also to maximize the functional outcome after the treatment. The surgical literature shows us that with preservation of these nerves there is a much higher rate of spontaneous erections after surgery and that the return to normal urinary function is also much improved.
The suitability of a man for this type of surgery will depend on several factors. Most importantly is the type of prostate cancer that a man has. This will be determined predominantly by three main characteristics:
- Initial PSA
- Gleason score (appearance of the prostate cancer demonstrated in the biopsies)
- DRE findings (how the prostate feels when examined by the urologist)
Nerve sparing surgery is our standardised approach to this surgery. Reasons for not been as aggressive with nerve sparing include a palpable nodule on the prostate, a PSA > 10ng/ml or a primary Gleason pattern > 4. For those men with these characteristics an incremental nerve spare is more a suitable surgical option. This means that a small amount of tissue containing a thin section of the neurovascular bundle, is left on the prostate but that the majority of the nerve tissue is preserved. The aim of this is to maximise the cancer cure rate whilst aiming not to compromise on functional outcomes such as sexual function and urinary control.
Details of the surgery
LRP is performed under general anaesthesia (the patient is asleep) and takes around 2-3 hours to perform. After the laparoscopic surgery, the majority of patients spend 1 night in hospital before returning home, in contrast to an average of 5 days for an open radical prostatectomy performed in Australia. Men undergoing LRP will have a catheter (small plastic tube) passed through the urethra (outlet pipe of the bladder- the one you pass water through) that will stay in place for one week. After that time men will return to the hospital for a trial of void.
Prior to removing the catheter a dye test is performed to ensure that the seal between bladder and urethra has healed.
Following this, the catheter is removed (not painful- sounds worse than it is) and upon passing urine normally men may then return home.
The advantages of LRP are that of improved visualization, reduced blood loss, almost elimination of blood transfusion, reduced post operative pain, a shorter hospital stay and a more rapid return to normal activity.
In our experience, of several hundred cases, we have achieved consistently low positive surgical margin rates (the likelihood of cancer being at the point of resection on the prostate surface), excellent urinary control and sexual outcomes.
LRP is offered at John Flynn Hospital, St. Vincent’s Hospital, Lismore and Lismore Base Hospital.