Performing laparoscopic prostatectomy

Laparoscopic prostatectomy of an oncological tumor of the prostate gland has been used since the 90s. All this time, medicine has improved the medical instrument, and surgeons gained experience

When to do laparoscopy

Over the past 20 years, medicine has clearly defined the line when this surgical intervention can be performed, and when it is contraindicated.

Laparoscopy of the prostate is prescribed for:

• absent metastasis with infiltration of cancer tissues in adjacent organs (cancer cells are present in the border of the prostate capsule);
• when the patient's life is predicted for ten years or more;
• with a prostate volume of 80 cc;
• other pre-laparoscopic treatments are not effective.

Contraindications for laparoscopic intervention:

• previous intervention on the urinary tract or prostate;
• stitches in the lower abdomen after surgery;
• the volume of the prostate is more than 100 cc (it is recommended to reduce the size to a possible 80 or less with the help of hormonal therapy);
• pathology of the cardiovascular system;
• overweight (obesity).

After assessing the indicators and the general condition of the patient, the specialist sums up the advisability of using laparoscopic treatment. Before deciding whether to perform a laparoscopy, the doctor assesses the pros and cons of removing the prostate.

Pros and cons of laparoscopy

Based on many years of experience in the application of minimally invasive techniques, we can highlight the main advantages and disadvantages of endoscopic resections.

The positives include:

• not long hospitalization;
• minor blood loss;
• a quick recovery period for the basic functionality of the urinary and reproductive system;
• not long-term use of the strongest pain medications;
• performing the operation with nerve-saving instruments, which does not affect erectile function;
• no scars remain after operations (traces of punctures with a diameter of 5-10 mm, after healing they become invisible).

The disadvantages of removing prostate tumors by laparoscopy include:

• limiting the field for performing operational manipulation;
• The prognosis for a patient's future life depends on the surgical skill.

The effectiveness of the laparoscopic method for removing a tumor can be reduced by a measure of tumor growth. The technique for cancer pathologies is classified within the limits of T1, T2.

Conducting laparoscopy for prostate cancer

The choice of laparoscopic prostatectomy surgery may have difficulties with the consequences of the operation. To avoid complications, surgeons carefully select the procedure for the procedure. The choice depends on the patient's condition with the required achievement results.

Despite the chosen method of the operation, patients are given general anesthesia, which is selected according to the age category and other characteristics of the patient's body. The specialist finds out the patient's allergic dependence and the presence of cardiovascular diseases.

Before introducing anesthesia, specialists put the patient in the Trandelenburg position. In this case, without fail, the legs must be divorced to the sides. After the anesthesia takes effect, the surgeon proceeds to the operation.

Initially, small incisions are made through which the ports (trocars) are inserted, this is necessary in order to install the set of instruments:

• Laparoscope.
• Camcorder.
• Endoscope.
• Next, the operation is performed using the selected method.

Surgical intervention through the peritoneal cavity

Transperitoneal surgery is a commonly used technique.

This operation is carried out in the course of the following manipulations:

• The surgeon inserts a special needle into the abdominal cavity, which is connected to a carbon dioxide balloon. This is necessary so that CO is injected in the iliac space. This action helps to increase the space of the working area, for carrying out the operation with greater accuracy.
• Then the laparoscopic port is installed with the introduction of the camera. The surgeon carefully examines the peritoneal and pelvic organs, after which the section that connects the peritoneal cavity and the organs within it is dissected.
• Through the formed space, internal organs are viewed to determine the affected area with cancer.
• Then the doctor performs an excision of the prostate gland, a particle of the urethra, after which the remaining canal is sutured to the ureter and its neck.
• After performing the manipulations, the surgeon installs the drainage.
• The surgeon assesses the internal condition for possible bleeding.
• The remote hardware is being pulled out, moved to a package that was also injected on the port.
• Then the instruments are removed, the punctures in which they were installed are sutured.

In practice, it has been proven that the transperitoneal method has its advantages:

• free movement during surgical manipulation;
• simple connection of urea with urethral residues;
• The disadvantages of such surgery include trauma to the peritoneal tissues, which is possible by adhesive consequences that can provoke intestinal obstruction.

Surgical intervention, bypassing the abdominal cavity

The extraperitoneal technique is performed without affecting the patient's peritoneal space, which differs from the transperitoneal operation.

This laparoscopy is performed according to the following scheme:

• the installation of the first port is carried out in the near-strength zone;
• a balloon expander is being inserted to increase the working area;
• at the next stage, the remaining trocars are inserted (the ports must all be installed in the subperitoneal space;
• the prostate, seminal vesicles, lymph nodes are removed (the removal method is the same as for the transperitoneal procedure).

What are the advantages of extraperitoneal access:

• the operation is allowed even for those patients who have already undergone surgery;
• the technique is called sparing, since during its implementation the rectum, the nerve endings that are responsible for erectile functioning are not damaged.

The final positive factor of this operation depends on what erectile function the patient had before the operation, oncological processes in the nerve bundles, the need to preserve sexual functions.

Operation with robot-assisted laparoscopy

Robotic laparoscopy is performed only in large medical urology centers outside of Israel or Germany.

The operation is performed by a Da Vinci robot under surgical supervision. When carrying out such an operation, the risk of postoperative complications due to specialist error is reduced.

Only a highly qualified doctor - oncologist can control a robotic operation.

When choosing a radical prostatectomy (RPE) by the laparoscopic technique, special attention is paid to the experience of the team of surgeons, the availability of equipment, and the financial capabilities of patients.

Possibility of complications in the postoperative period

Laparoscopy is called a minimally invasive operation, which has minimal negative consequences. After surgery with the removal of the prostate, the patient returns to the ward and is awakened.

The entire postoperative period, which takes place within the walls of the clinic, lasts about a week. The rehabilitation period takes place in stages.

Laparoscopic radical prostatectomy - it is possible to save the patient's life by removing a cancerous tumor.