Q&A: Laparoscopic Prostatectomy

Laparoscopic radical prostatectomy (LRP), removal of the prostate gland through laparoscopic surgery, offers safe results and key benefits to prostate cancer patients, specialists say.

Although most prostatectomies are performed using traditional open surgery, the number of laparoscopic procedures has risen steadily in recent years as more surgeons have become trained in the procedure and patients have become aware of it.

Answering questions about laparoscopic radical prostatectomy is Surena Matin, M.D., assistant professor in M. D. Anderson's Department of Urology, who has performed more than 500 laparoscopic urologic cancer surgeries.

What is laparoscopic radical prostatectomy?

During LRP, surgeons place a thin tube containing a tiny camera (laparoscope) through a small incision in the abdomen. They then make additional small incisions and remove the prostate, while viewing a monitor showing the camera footage to guide them.

Laparoscopic radical prostatectomy is the fastest-growing laparoscopic procedure in urology in the United States and maybe the world. LRP was introduced in the early 1990s then refined by French surgeons in 1999.

How is LRP different from traditional prostatectomy?

LRP involves four -inch punctures and a 1 -inch incision around the navel, as compared to the typical (8- to 9-inch) lower midline incision required for traditional open surgery.

LRP surgeons can do everything that other surgeons can do during an open prostatectomy, including lymph node removal and sparing the nerves responsible for erection. LRP surgeons look at a monitor while operating, so the procedure is highly technical and requires a great deal of training and experience.

What advantages does LRP have over open surgery?

• Less bleeding
• Faster recovery time
• Shorter hospital stays
• Less fluid buildup
• Decreased reliance on pain medications
• Less time required for urinary catheter (up to a week less)

Which patients are eligible for LRP?

Patients are eligible for LRP if they have:

• No prior pelvic surgery or radiation treatment
• A PSA level less than 15 (the PSA test measures a protein in the blood)
• A Gleason score of 7 or less (indicator of cancer aggressiveness)

How long is the procedure?

LRP takes approximately three to four hours. If there is no lymph node removal or nerve sparing, the surgery is approximately 2-2 hours long.

Are the results of LRP the same as with open surgery?

So far, the results are similar - both in the removal of the prostate, containing the tumor, and the incidence of treatment side effects such as incontinence and erectile dysfunction. Because LRP is a relatively new procedure, there have been no long-term studies comparing it to traditional surgery methods.

How can patients find the right surgeon to perform LRP?

Generally, the most proficient and skilled LRP surgeons will be recruited to centers that see a high volume of patients. They must be trained specifically in laparoscopic surgery. Fifty laparoscopic surgeries appear to be the minimum number of procedures in which a surgeon is considered proficient in LRP.

What is the future for LRP?

The new trend in LRP is robotic laparoscopic radical prostatectomy - using a robot to perform LRP. Surgeons sit at a virtual-reality type of console and make the actual hand movements required in the surgery, while robotic arms actually perform the operation. The advantages include the elimination of minor hand tremors, somewhat (or possibly) better precision and more range of motion.

We will be starting up our robotics program at M. D. Anderson soon. We have been approved to buy a robot, are hiring a new surgeon already trained in robotics and have been training existing surgeons in robotic laparoscopy.