Classical Prostatectomy: the median incision below the umbilicus

The execution of radical prostatectomy with laparoscopy

It is not necessary in laparoscopy, unlike other surgical techniques, to place the patient on the operating table in a position that imposes significant constraints on the spine that can cause post-operative sciatic pain.

How long does a radical prostatectomy with laparoscopy take?

This surgery requires an average of 3 hours of operating time, depending on the difficulties encountered and the possible need to perform a lymph node dissection (lymphadenectomy).
Its duration when performed by a trained surgeon in the practice of laparoscopy is no longer than the standard open radical prostatectomy.

However the postoperative period is more comfortable with the laparoscopic approach and the amount of antalgesic medication needed to combat immediate post-operative pain is significantly reduced.

After surgery, the patient wakes up quickly and is monitored in a post operation post-op unit located in the operating theater.
The patient then later returns to their room.

The urinary catheter, which drains the bladder’s urine and is put in place by the surgeon at the end of the operation to allow cicatrization of the suture between the bladder and the urethra (vesicourethral anastomosis) and on average, may be withdrawn seven days after the procedure.
In our practice, the catheter is removed by the radiologist during opacification that verifies the cicatrization of the anastomosis. This examination is performed externally, because the patient usually leaves the clinic with the catheter between the 3rd and the 5th postoperative day.

What are the advantages of radical prostatectomy with laparoscopy?

Classical Prostatectomy: the median incision below the umbilicus

Classical radical prostatectomy

Conventional open radical prostatectomy for the removal of prostate cancer requires a vertical incision on the lower part of the abdomen from the navel to the pubis.

Exposing the operative field is complicated because the prostate is difficult for the surgeon to access and because the bottom of the pelvis, is an area readily hemorrhagic for surgery.

Specific facilities are described by some surgeons to facilitate exposure, with hypercambrure of the spine or limbs below the pelvis, both of which can cause nerve stretching.

Prostatectomy with laparoscopy: the points of introduction of trocars

Prostatectomy with Laparoscopy

Micro-invasive surgery by laparoscopy, whether conventional or robot-assisted requires only 5-6 small incisions of 5 to 12 millimeters in length in order to introduce the optical of the endoscope and the surgical instruments (keyhole incisions).

Laparoscopic prostatectomy offers the surgeon a magnified view of the operative field (up to 30 times magnification) allowing unprecedented precision in the removal of the prostate.
Bleeding during the procedure is also significantly reduced because the low-pressure venous system is maintained by the abdominal hypertension created by the gas, and the use of blood transfusions is not usually needed.

Additional benefits :

  • A reduction in the duration of hospitalization (on average patients leave 4 days after the procedure with their urinary catheter that is removed by a nurse at their home, or in our practice by the radiologist after opacification) and faster recovery time;
  • A reduction in postoperative pain making administration of analgesic drugs virtually unnecessary;
  • A shorter convalescence period;
  • A faster return to their day to day activities including their professional lives;
  • A reduction in the frequency of occurrence of postoperative eventrations and other complications of the wall due to short incisions.

Recovery of erections (when the neurovascular bundles can be preserved) and continence is comparable to conventional “open” operations.

Patients are informed prior to the completion of the procedure of the possibility of achieving it by laparoscopy, under the condition of not being forced to convert intraoperatively to a classic open surgery due to unforeseen complications encountered.
This is a rare eventuality.