Laparoscopic Surgery for Prostate Cancer
What is Laparoscopic Surgery?
Laparoscopic surgery, also known as keyhole radical prostatectomy, is a surgical treatment used to treat localised prostate cancer.
It is a minimally invasive operation and a more advanced form of prostatectomy. The aim of the procedure is to remove the prostate and the cancerous cells.
Laparoscopic surgery is less aggressive than open surgery, as the operation is performed via small incisions and by inserting a camera and special instruments into the abdomen.
This approach minimises possible complications, such as blood loss, besides requiring shorter hospital stays and speeding up patient recovery.
What is the Procedure?
Laparoscopic radical prostatectomy is a surgical procedure whose main aim is to remove the prostate and other adjacent organs.
During surgery, the prostate, seminal vesicles and part of the ductus deferens are removed.
The patient is put under general anaesthetic. The surgeon inserts instruments through the abdominal wall via very small incisions (5–12 mm in diameter) rather than the longer incision used in open surgery.
A microscopic video camera on one of the instruments films the inside of the patient’s body and is used by the medial team performing the surgery.
Like any operation, there are risks associated with this medical procedure, such as:
- Complications, like allergic reactions, related to the anaesthetic;
- Adjacent organ lesions;
However, keyhole surgery is much less invasive and aggressive compared to other more radical treatments, such as classical open surgery.
After the operation, patients sometimes complain about urinary incontinence and erectile dysfunction. Normally, these gradually wane over time. If they persist, it is important to discuss the symptoms with the doctor following the case or at specialist centres treating prostate cancer and its consequences.
Indications for Laparoscopic Surgery
The treatment is suitable for the same situations as classical open surgery, with no limits in terms of prostate volume, PSA or Gleason grading (indicating tumour aggressivity).
The inclusion criteria are the same as other curative techniques. This technique should be considered for patients with clinically localised tumours (≤ T2cTNM classification) or, in some cases, locally advanced tumours (i.e. T3 in the TNM classification).
The PSA level and Gleason grading are important prognostic indicators that should be incorporated into instruments like the classic Partin tables – tools used to ascertain a patient’s likelihood of having a localised, locally advanced or advanced tumour.
This data, together with information obtained from a digital rectal exam, details such as the patient’s age, additional test results (such as ultrasound, NMR, CT scans, bone scintigrams and PET) and even new tumour markers, allow assessment of the probability of a localised tumour at a more advanced stage and calculation of the risk of curing the illness or its evolution or recurrence.
Various prognostic indicators are available and accessible online that can be used for this purpose relatively simply.
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What is the Post-Treatment?
After surgery, patients usually remain in hospital for 2 to 5 days depending on their speed of recovery.
After prostate cancer treatment, some tests must be taken to ensure the tumour has not returned and other related/unrelated problems have not arisen.
Follow-up typically takes place every 3 months during the first year after surgery.
The most important test is PSA, which must be done regularly for at least 15 years. After radical surgery, the level must be undetectable or very low.
Some patients also require psychological help, both before and after treatment, to minimise the impact after discovery of the illness.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Laparoscopic Surgery for Prostate Cancer
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- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- DIAS, José Santos. Tudo o que sempre quis saber sobre a Próstata. Lisboa: Lidel - Edições Técnicas, Lda, 2014.
- What is laparoscopic surgery for prostate cancer?
- Surgery for Prostate Cancer - https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html
- Laparoscopic Pyeloplasty Pre- and Postoperative Instructions - https://www.hopkinsmedicine.org/brady-urology-institute/specialties/divisions-programs/minimally-invasive-surgery/kidney-blockage-or-cysts/laparoscopic-pyeloplasty.html