The word "laparoscopy" means to look inside with a special camera or scope. Surgery done 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 belly 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 prostatectomy is 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.
Laparoscopy appears to treat 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 1 or 2 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 1 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 2 to 3 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 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 3 months.
Because this technique is nerve-sparing, a man's postoperative ability to have an erection should be comparable to that of traditional surgery. Recent studies have shown no difference between laparoscopic surgery and 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 about your health history, and your doctor will give you a general physical exam. If your intestine needs cleaning, you will be given a prescription for a laxative medicine to take the evening before the surgery.
All patients are asked for a blood sample. Depending on your age and general health, you may also have an EKG, a chest X-ray, lung function tests, or other tests to check 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 put a small needle just below your belly button, into your abdominal cavity. The needle is connected to a small tube that passes carbon dioxide into the belly. This lifts the abdominal wall to give the surgeon a better view once the laparoscope is in place.
Next, a small cut 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 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, more small cuts 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 and 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 give you more specific guidelines.
Nausea and vomiting are common 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 6 weeks after surgery, you should not lift or push anything over 30 pounds and should not do abdominal exercises such as sit-ups.
Self-care After Surgery
To speed your recovery from prostate cancer, it's helpful to know about some self-care you can do at home. Note that these are general guidelines and may not apply to every patient. Always follow your doctor's specific instructions for care after treatment.
- Small pieces of tape called Steri-Strips, if used, may remain over the incision site and may be removed 10 to 14 days after surgery. The incision should be kept clean and dry for a week after surgery. Ask your doctor when you may take a shower or bathe. Do not go swimming until you have discussed this with your doctor at your follow-up appointment.
- You will be given a prescription for pain relief after the procedure. You may also take Extra Strength Tylenol as directed by your doctor. Do not take aspirin or products containing aspirin for the first 3 days after the procedure.
- The area may be black and blue right after the procedure. This will go away in a few days. Numbness, tingling, or discomfort is normal.
- Consult your doctor before resuming any physical activity.
- Most men can resume driving 10 to 14 days after surgery. Ask your doctor for specific advice.
- Your doctor will let you know when you can resume having sex.