Laparoscopic Radical Prostatectomy

Laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical procedure used to remove the prostate gland in patients with localized prostate cancer. The goal of the surgery is to remove the cancerous prostate gland and surrounding tissues, while preserving the nerves that control urinary and sexual function.

Indications

LRP is typically indicated for patients with:

• Localized prostate cancer (cancer that has not spread beyond the prostate gland)
• Prostate cancer that is confined to one or both lobes of the prostate gland
• Patients who are at high risk for complications from traditional open surgery
• Patients who want to minimize scarring and recovery time

Surgical Technique

The LRP procedure involves several steps:

1. The patient is given general anesthesia and positioned on the operating table.
2. A small incision (about 1 cm) is made in the navel, and a laparoscope (a thin, lighted tube with a camera) is inserted through the incision.
3. Several additional small incisions are made in the abdomen, and specialized instruments are inserted to assist with the surgery.
4. The surgeon uses the laparoscope and instruments to dissect the prostate gland from surrounding tissues and blood vessels.
5. The prostate gland is then removed through one of the small incisions.
6. The urethra is reconnected to the bladder, and the surrounding tissues are closed.

Benefits

LRP offers several benefits compared to traditional open surgery:

• Less blood loss: LRP typically results in less bleeding than open surgery.
• Less pain: Patients often experience less post-operative pain with LRP.
• Faster recovery: LRP patients can usually return to normal activities within 1-2 weeks, compared to 4-6 weeks with open surgery.
• Smaller incisions: The small incisions used in LRP result in less scarring and a more cosmetically appealing outcome.
• Preservation of nerve function: LRP allows for better preservation of the nerves that control urinary and sexual function, reducing the risk of impotence and incontinence.

Risks and Complications

As with any surgical procedure, there are risks and complications associated with LRP:

• Bleeding or hemorrhage: Excessive bleeding during or after surgery.
• Infection: Bacterial infection of the urinary tract or surgical site.
• Urinary incontinence: Temporary or permanent loss of bladder control.
• Impotence: Difficulty achieving or maintaining an erection.
• Bowel injury: Accidental damage to the bowel during surgery.
• Adhesions: Formation of scar tissue in the abdomen.

Post-Operative Care

After LRP, patients typically:

• Spend 1-2 days in the hospital for recovery and monitoring.
• Experience some discomfort, pain, or numbness in the groin area.
• May have a urinary catheter in place for several days to help with bladder function.
• Should avoid heavy lifting, bending, or strenuous activities for 4-6 weeks.
• Can usually return to normal activities within 1-2 weeks.

Follow-Up Care

After LRP, patients will need to follow up with their surgeon and urologist for:

• Post-operative check-ups: To monitor healing and remove any sutures or staples.
• PSA testing: To monitor prostate-specific antigen levels and detect any potential recurrence of cancer.
• Urinary function evaluation: To assess bladder control and urinary function.
• Sexual function evaluation: To assess erectile function and address any concerns or issues.