Laparoscopic and Robotic Radical Prostatectomy - An Overview

Introduction:

Prostatectomy is a standard surgical procedure used to treat prostate diseases such as benign prostate hyperplasia and prostate cancer. In an open prostatectomy, the surgeon makes an incision in the lower part of the abdomen to remove the prostate gland. Since open prostatectomy is an invasive surgical procedure, it often results in severe complications, prolonged hospital stay, and discomfort to the patient. Due to severe complications associated with open prostatectomy, patients often become reluctant towards it. Laparoscopic and robotic-assisted radical prostatectomy are minimally invasive surgical procedures considered ideal alternative to open prostatectomy. These minimally invasive techniques show fewer complications than open prostatectomy.

What Is the Difference Between Simple and Radical Prostatectomy?

1) Simple Open Prostatectomy: Simple open prostatectomy is a surgical procedure in which the inside part of the prostate gland is removed rather than the entire prostate gland. It mainly treats benign prostate hyperplasia (non cancerous prostate gland enlargement). In a simple open prostatectomy, the surgeon uses traditional surgical tools to make an incision on the lower part of the abdomen. It is contraindicated in prostate cancer since it can lead to recurrence.

2) Radical Prostatectomy: Unlike simple open prostatectomy, radical prostatectomy involves the surgical removal of the entire prostate gland. It is used in the treatment of localized prostate cancer. Radical prostatectomy can be performed using different techniques such as;

• Open Radical Prostatectomy - The surgeon makes an incision on the lower part of the abdomen using traditional surgical tools to remove the entire prostate gland.

• Robotic-Assisted Radical Prostatectomy - It is a minimally invasive surgical procedure in which the surgeon makes several incisions in the patient's abdomen using miniaturized robotic instruments.

What Is Laparoscopic Radical Prostatectomy and How Is It Performed?

Laparoscopic radical prostatectomy is a minimally invasive surgical procedure used to treat localized prostate cancer. The procedure of laparoscopic radical prostatectomy is as follows,

• The doctors will ask the patient to have a clear liquid diet before surgery. Medications other than what the doctor prescribes to take before surgery are avoided. If the patient has a habit of drinking alcohol and smoking, it should be stopped a week before surgery to prevent complications.

• On the day of the surgery, the patient is primarily given general anesthesia by the doctor before surgery. It keeps the patient in a sedative state during the surgery.

• After giving anesthesia, the surgeon places several small incisions on the lower abdomen to which small disposable trocars are inserted. Trocars are small medical devices placed through abdominal incisions during laparoscopic surgery.

• The surgeon then inserts long, thin surgical instruments and a laparoscope through the trocars to access the prostate gland.

• A laparoscope is a small fiberoptic instrument that aids in viewing the internal structures of the abdomen by depicting live images on a computer. With the help of images produced by the laparoscope, the surgeon removes the entire prostate gland with much precision. The seminal vesicles (a small pair of glands found near the prostate gland) are also removed along with the prostate gland.

The surgery usually takes three hours to perform. After surgery, the patient will be made to stay in the hospital for two to three days, where the healthcare providers will monitor the recovery process.

What Is Robotic Radical Prostatectomy and How It Is Performed?

Robotic radical prostatectomy is a minimally invasive technique in which automated surgical instruments aid in the removal of the entire prostate gland. It is performed as follows;

• Firstly, the patient will be given general anesthesia, not to feel any pain or discomfort throughout the surgery. Antibiotics will be given before surgery via injection to prevent postoperative infections.

• The surgeon then makes five small keyhole incisions in the lower abdomen through which miniaturized robotic instruments and an endoscope are inserted.

• The endoscope is a small medical device that helps examine internal body structures. In robotic radical prostatectomy, the endoscope displays high-magnified live images of the structures surrounding the prostate gland on a monitor. The endoscope's live images help the surgeon to surgically remove the prostate gland with much precision.

• The surgeon eventually removes the prostate gland by manipulating the miniaturized surgical robotic instruments through one of the incisions.

• Following surgical removal of the prostate gland, the surgeon places an intracorporeal suturing (a suturing technique used in laparoscopic surgery) to avoid any severe complications.

What Are the Side Effects of Laparoscopic and Robotic Radical Prostatectomy?

The major side effects of laparoscopic and robotic radical prostatectomy include the following;

• Erectile Dysfunction: Erectile dysfunction is one of the most common symptoms of prostatectomy. After radical prostatectomy, most men experience temporary erectile dysfunction. However, the degree of erectile dysfunction after radical prostatectomy depends on the age and degree of preoperative sexual function. To minimize erectile dysfunction, the surgeons will carry out nerve-sparing techniques during radical prostatectomy.

• Urinary Incontinence: Urinary incontinence is the inability to control urine due to a loss of bladder control. After laparoscopic and robotic radical prostatectomy, the patient suffers from urinary incontinence temporarily. However, the side effect usually gets resolved with time.

• Sterility: Sterility refers to the inability of a male or female to produce offspring. It can be corrected by proper medical intervention.

• Changes in Penis Length: The penis size may become small after surgery due to shortening of the urethra, which happens when a small portion of the urethra is removed along with the prostate gland.

• Inguinal Hernia: An inguinal hernia is a condition in which the soft tissues of the abdomen protrude through a weak area in the abdominal wall. People who have undergone radical prostatectomy have increased chances of developing an inguinal hernia.

Laparoscopic and robotic radical prostatectomy are minimally invasive surgeries, yet they have some potential risks associated with them, such as;

• Bleeding.

• Postoperative infections around the surgical site.

• Tissue or organ damage.

What Are the Advantages and Disadvantages of Laparoscopic and Robotic Radical Prostatectomy?

The significant advantages and disadvantages of laparoscopic and robotic radical prostatectomy over open radical prostatectomy includes;

Advantages:

• Minimally invasive.

• Less blood loss.

• Less postoperative pain.

• Shorter hospital stays.

• Recovery time is shorter.

Disadvantages:

• Laparoscopic radical prostatectomy has longer operating hours than an open radical prostatectomy.

• Expensive.

Conclusion:

Advancements in surgical technology have leaped over traditional surgical techniques in recent years. Laparoscopic and robotic radical prostatectomy has significantly reduced the morbidity rate in pancreatic cancer. Robotic radical prostatectomy shows better outcomes than laparoscopic and open radical prostatectomy since the surgery is more precisely done.