The word laparoscopy means to look inside the abdomen with a special camera or scope. Surgery performed with the aid of these cameras is known as laparoscopic, keyhole, porthole, or minimally invasive surgery.
Traditional surgery requires a long incision (cut) down the center of the abdomen and a lengthy recovery period. Laparoscopic surgery eliminates the need for this large incision. As a result, you may have less pain and scarring after surgery, faster recovery, and less risk of infection.
Laparoscopy for prostate removal is a common procedure. Men who undergo this technique have less blood loss, less need for pain medication, shorter hospital stays, quicker return to regular activities, early removal of urethral catheters (tubes inserted through the penis to drain urine from the bladder), and a quicker recovery.
Robotic-assisted radical prostatectomyis an increasingly popular surgery that is done through small incisions in the belly with robotic arms that translate the surgeon's hand motions into finer and more precise action. Learn more at Radical Prostatectomy.
Laparoscopy appears to treat the prostate cancer as effectively as surgeries done with a large incision.
What Are the Advantages of Laparoscopy?
As is the case with other minimally invasive procedures, laparoscopic prostate removal has significant advantages over traditional surgery:
- Laparoscopy can shorten your hospital stay to one or two days. About 50% of men are discharged one day after surgery. (The length of stay depends on how quickly you recover and the extent of the surgery.)
- There is much less bleeding during the operation.
- You are less likely to need prescription painkillers after you leave the hospital. Patients often need nothing more than Tylenol.
- At your follow-up appointment one week after surgery, the tube, or catheter, draining your bladder will be removed if there are no signs of other problems. Occasionally, the catheter remains in place for another week, as with conventional surgery.
- About 90% of patients can return to work or resume full activity in only two to three weeks.
Am I Eligible For This Surgery?
You may be eligible if you have prostate cancer that has not spread outside of the prostate and is not very aggressive. You may not be eligible if you have had previous open or laparoscopic pelvic surgery, even for another reason.
What Are The Side Effects?
Medical research so far shows that symptoms of incontinence and impotence are similar for both minimally invasive surgery and traditional surgery. Men usually return to normal urinary function within three months.
Because this technique is nerve-sparing, a man's postoperative sexual potency rate (the ability to achieve an erection) should be comparable to that of traditional surgery. Recent studies have shown no difference in potency between laparoscopic surgery and more traditional open surgery called open radical prostatecomy (ORP).
How Do I Prepare For Surgery?
Your surgeon will meet with you to answer any questions you may have. You will be asked questions about your health history and your doctor will give you a general physical exam. If your intestine requires cleaning, you will be given a prescription for a laxative medicine to take the evening before the surgery.
All patients are asked to provide a blood sample. Depending on your age and general health, you may also have an EKG (electrocardiogram), a chest X-ray, lung function tests, or other tests to evaluate your body's ability to handle the stress of surgery.
Finally, you will meet with an anesthesiologist who will discuss the type of anesthesia you will be given for surgery. You will also learn about pain control after the operation, which might include a PCA (patient-controlled analgesia) pump.
What Happens During Surgery?
Your surgeon will place a small needle just below your belly button and insert it into your abdominal cavity. The needle is connected to a small tube that passes carbon dioxide into the abdomen. This gas lifts the abdominal wall to give the surgeon a better view of the abdominal cavity once the laparoscope is in place. The surgeon will then be guided by the laparoscope, which transmits a picture of the prostate onto a video monitor.
Next, a small incision will be made near your belly button. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.
Before starting the surgery, the surgeon will take a thorough look at your abdominal cavity to make sure the laparoscopy procedure will be safe for you. If the surgeon sees scar tissue, infection, or abdominal disease, the procedure will not be continued.
If the surgeon decides the surgery can be safely performed, additional small incisions will be made, giving them access to the abdominal cavity. If necessary, one of these small incisions may be enlarged to remove the pelvic lymph nodes.
What Happens After Surgery?
You can expect to follow a liquid diet at first, then gradually be able to eat solid foods. When you go home, you will follow a soft diet, which generally means no raw fruits or vegetables. A dietitian can provide more specific dietary guidelines.
Nausea and vomiting commonly occur because the intestines are temporarily disabled during anesthesia and surgery. Your doctor can prescribe medications to relieve these symptoms, which will improve a few days after surgery.
You will be encouraged to get out of bed and walk as much as possible, starting the first day after surgery. You should steadily increase your activity after you go home. For six weeks after surgery, you should not lift or push anything over 30 pounds, and should not do abdominal exercises such as sit-ups.