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| | Laparoscopic Radical Prostatectomy: A Minimally Invasive Approach to the Treatment of Prostate Cancer
David B. Samadi, MD
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| It is estimated that 198,000 American men will be diagnosed with prostate cancer and approximately 38,000 will die of the disease this year alone. About one third of prostate patients choose a surgical option as the treatment of their prostate cancer.
Traditional open surgery requires making a large incision to remove the cancerous prostate. A larger incision means more pain, higher risk of infection, longer recovery period and chance of bleeding. Most patients also have to carry a catheter for a period of two to three weeks. In order to improve the quality of life with a similar oncological outcome, another advanced technology, state of the art, minimally invasive surgery is offered at New York Presbyterian Hospital called Laparoscopic Radical Prostatectomy.
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Now one can remove the prostate through five small "key hole" incisions. As a result, there is a much lower risk of bleeding and transfusion, decreased catheterization time and use of postoperative pain medication. Under a 10 15 magnification of the site, one can see the anatomy much clearer including blood vessels and neurovascular bundles responsible for sexual function.
The advantages of this procedure are great:
- Shortened hospital stay to one or two days. Majority leave on the first day.
- Significantly less bleeding, lower risk of blood transfusion.
- Minimal requirement for pain medications after discharge from the hospital.
- Removal of catheter on day three compared to 2 3 weeks with open surgery.
- 90% able to resume normal activity within one week after operation.
- Vision magnification of the site is outstanding (approximately 10 15 times higher magnifications).
- Improved cosmetic results.
Questions & Answers about Laparoscopic Radical Prostatectomy
The surgery was first performed in United States in the early 1990s but then abandoned due to the extraordinary time to perform the operation. It was revived in the late 1990s by surgeons in Paris who modified some of the techniques, therefore making it a safe, efficient and reproducible procedure. This has resulted in a higher continence and potency rate. Over 95% of patients are fully continent and 70% are potent within six months. This positive margin is comparable to results of traditional open surgery.
As a uro-oncologist, the most important issue is removing the prostate cancer intact with negative margins. The next most important goal is for patients to be fully continent and potent. The results of Laparoscopic Radical Prostatectomy so far have been comparable to open surgery.
The recovery time after a traditional open surgery is about four to six weeks, whereas Laparoscopic Radical Prostatectomy patients can return to normal activity within a week.
Laparoscopic Radical Prostatectomy remains a challenging operation partly because of the location of the prostate and partly because of the complex steps involving the prostatectomy such as sparing the nerve bundles and urethrovesical anastomosis.
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"By submitting this information, I write not only to compliment you and your wonderful staff, but also to advise patients with prostate cancer, from my region, the Caribbean, of the benefits of robotic prostatectomy". 
