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Radical laparoscopic prostatectomy is one of the surgical treatment methods for prostate cancer. The great advantage of laparoscopic prostate removal is the low invasiveness of such an operation. Who can be operated in this way? How does radical prostatectomy work with the laparoscopic method?

Radical prostatectomy with the laparoscopic methodtosurgical removal of the prostate glandwith seminal vesicles, fragments of the vas deferens and sometimes, depending on the assessment of the risk of metastases surrounding lymph nodes.

Radical prostatectomy is performed in patients with prostate-limited prostate cancer or with locally advanced metastatic cancer, as an introduction to multimodal treatment. The radical prostatectomy procedure is performed under general anesthesia using the open method, laparoscopy or with robot assistance.

Urologist Łukasz Curyło from SCM clinic in Krakow emphasizes that the choice of prostate cancer treatment method depends on many factors, is always preceded by an accurate diagnosis and interview, and ultimately is an individual decision of the treating physicians and the patient.

The method of treating this type of cancer depends, among other things, on:

  • patient's age
  • stage of the disease
  • spit
  • coexistence of other diseases

Each patient should be thoroughly informed about the nature of the disease, possible forms of treatment and the possible risk of complications or side effects of therapy.

There are many different ways of treating prostate cancer: from active surveillance, through surgery, to broadly understood radiotherapy, as well as experimental minimally invasive treatment, e.g. with HIFU. One of the methods of treating prostate cancer is radical prostatectomy, and the one performed laparoscopically is currently the least invasive method of surgery.

- Laparoscopy is currently the least invasive method of surgery. Complications occur less frequently than in the case of open organ surgery, and the patient is not exposed to a long period of convalescence, thanks to which he quickly regains operational efficiency - explains the SCM Clinic specialist.

Radical prostatectomy using the laparoscopic method:qualification

The qualification for the procedure is determined by the results of histopathological tests and the level of PSA, i.e. the specific prostatic antigen. They are supplemented with imaging tests: magnetic resonance imaging and computed tomography, and when bone metastases may be involved, also scintigraphy.

Radical prostatectomy using the laparoscopic method: course

The laparoscopic radical prostatectomy procedure involves introducing special devices into the patient's body through a very small, approx. 10 mm incision, made in the abdominal wall, just below the navel.

The set of tools that are introduced this way consists of optics that allow you to enlarge the organs on the screen of a medical monitor (laparoscopic camera) and laparoscopic instruments, i.e. special microtools that allow you to incise, cut, transform and pull them into outside fragments of diseased tissues. The optical magnification obtained during the procedures allows for very precise preparation of structures, and the electrosurgical tools used allow minimizing blood loss during the procedure.

After making the incisions, access to the tools can be made bluntly with a finger or with the use of a Gaura balloon. The working space is filled with carbon dioxide introduced under pressure. In this way, a pneumothorax is artificially produced, which provides space for the tools and reduces bleeding during surgery.

The prostate excision operation begins with the dissection of its anterior surface and freeing it from the pelvic fascia. The prostate is then cut from the bladder neck.

In the next step, the longest section of the urethra is prepared, which will later be used to connect with the bladder. The surgeon also dissects the seminal vesicles and distal ends of the vas deferens, which are severed and coagulated.

The last and most important part of the procedure is restoring the continuity of the urinary system, i.e. connecting the bladder with the urethral stump, which remains after the removal of the prostate. After the anastomosis, a leak test is performed, which consists in filling the bladder with a physiological saline solution.

Fragments of released and cut off diseased tissues, i.e. the prostate gland along with the seminal vesicles, are removed in a special bag through the previously widened opening below the navel.

Finally, carbon dioxide is released from the operating space, suturing is performed and a dressing is applied. The patient has drains that are removed a few days after the operation.

Radical prostatectomylaparoscopic method: contraindications

The basic limitations for the operation are the general condition of the patient and accompanying diseases, e.g.

  • ischemic heart disease
  • COPD
  • diabetes

Radical prostatectomy using the laparoscopic method: complications

Possible complications include:

  • narrowing of the bladder neck
  • urethral stricture
  • urine leakage or urinary fistula
  • urinary incontinence
  • impotence
About the authorBow. Łukasz Curyło Bow. Łukasz Curyło - urology specialist from SCM clinic in Krakow (www.scmkrakow.pl). A graduate of the Medical Academy in Krakow. He passed his specialization exam in urology in 2012, obtaining the FEBU (Fellow European Board of Urology) title. He works at the Clinical Department of Urology under the supervision of prof. Piotr Chłosta as a senior assistant. Since 2013, he has been the Head of the Clinical Urology Clinic. He actively participates in the scientific congresses of the Polish Society of Urology (PTU) and the European Society of Urology (EAU). I co-organize courses in the field of urology and minimally invasive techniques: laparoscopic and endoscopic. He is particularly interested in urological oncology, laparoscopy in urology and reconstructive procedures of the urinary tract.

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Category:

Oncology