Prostate Cancer Prostate Cancer Treatment

Picking a Prostate Surgery: The Laparoscopic Approach

While early prostate cancer is considered a highly treatable cancer, it often involves the surgical removal of the prostate, which is a male reproductive gland that stores a component of semen. Even though prostatectomy, as this operation is known, is usually successful, it has traditionally had a serious impact on men's lives. Because the prostate surrounds the urethra, incontinence following surgery is a concern and some men experience erectile dysfunction, though this is a less common side effect today because the nerves that control erection are carefully spared.

Traditionally, the gland is removed during open surgery, a fairly safe procedure that has typical surgical risks and a somewhat painful and long recovery period. But a new surgical approach to prostate removal called laparoscopy is making the surgery easier on men. In this procedure, a surgeon makes a number of small incisions, rather than one large one, and inserts into one incision a camera called a laparoscope that provides a magnified image of the area. This minimally invasive surgery was once used primary for tubal ligation and gallbladder surgery and is now available in select medical centers to people with prostate cancer. Studies show that laparoscopic prostatectomy offers patients less bleeding, less pain and a quicker recovery, allowing men to get back to normal activities sooner. Below, Jihad Kaouk, MD, a staff member of the Urological Institute at The Cleveland Clinic, discusses the benefits of this surgical technique in treating prostate cancer.

How has prostate cancer surgery traditionally been performed?
The standard way to remove the prostate has been the open surgery; the procedure is called a radical prostatectomy. In open surgery, the incision is in the midline, below the belly button to the pubic bone. The prostate sits between the bladder and the urethra, and the surgery is designed to remove the prostate completely with the seminal vesicle (that's a gland adjacent to it). One has to be very careful because continence is an issue so we make sure the bladder is stitched to the urethra so that urine can still flow out. And we are also careful about the nerves responsible for erections, so that's another very delicate area.

What is laparoscopic surgery?
Laparoscopic surgery is also known as "keyhole" surgery. It's doing the surgery through small incisions, which are each about one centimeter long. We use at least three incisions: one for the camera and two for the surgeon's instruments. We use CO2 gas to inflate the belly of the patient to create a space in order to do the surgery, and we use a scope that has a camera at its tip and a powerful light source so that we have a good image. We look at a TV monitor while doing the surgery, which gives us a very detailed picture of the anatomy and what we are doing.

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