The intervention can be realized according to several modalities.
The most classic and still most practised in France (but not in the United States) is the retro-pubic prostatectomy with open access in accordance with the Walsh technique, or its optimized variants.
This surgery is realized under general anesthesia, usually through a vertical section from the umbilicus to the pubis.
The laparoscopic radical prostatectomy (LRP) realizes the same excision with a less significant scar because it is practised through 4 to 6 small openings, each of the size of a keyhole.
The robot assisted laparoscopic prostatectomy (RALP) on DA VINCI system from Intuitive Surgical is a technique of automated laparoscopy which allows the surgeon, thanks to the use of a 4-arm manipulator handling the optic and the instruments, to recreate the conditions of a usual laparoscopic prostatectomy, but by sitting at a remote console of the patient.
The use of the robot reduces the duration of the long learning curve of the surgeon of laparoscopy – which is a difficult technique.
It brings him the comfort of vision in 3 dimensions, an ergonomic operating position, and an ease of manipulation of the instruments on 6 axes of rotation reproducing the movements of the human hand.
The robot cannot be programmed and does not make any decision by itself. Every movement of an instrument is made on the surgeons initiative.
In the perineal prostatectomy, the surgeon accesses the prostate through a low section situated between the scrotum and anus.
Few surgeon urologists in France have the knowledge of this method which is at present almost not used.
Indeed, if the comfort of the post-operative period is substantial with this perineal access, the risks of incontinence are more important than with the other techniques as well as erectile impotence.
If lymphadenectomy is necessary, it requires a second surgical access, either above the pubis by open way, or by laparoscopy.