Laparoscopic radical prostatectomy (LRP)

This is a type of keyhole surgery used to remove the prostate gland and the seminal vesicles as a treatment option for prostate cancer.

Traditionally radical prostatectomy was performed through a single incision that extended from the pubic bone to just below the umbilicus (belly button). This is not the case for LRP which uses instead, 5 small incisions through which ports or small tubes are placed. Specialized instruments and telescopic cameras are then inserted through the ports to perform the surgery in a precise manner facilitated by magnified vision.

In certain men a nerve sparing approach can be used. The nerves that are spared are the nerves that supply the erectile tissue within the penis. The aim of this type of surgery is firstly to cure the man of prostate cancer but also to maximize the functional outcome after the treatment. The surgical literature shows us that with preservation of these nerves there is a much higher rate of spontaneous erections after surgery and that the return to normal urinary function is also much improved.

The suitability of a man for this type of surgery will depend on several factors. Most importantly is the type of prostate cancer that a man has. This will be determined predominantly by three main characteristics:

1. initial PSA
2. Gleason score (appearance of the prostate cancer demonstrated in the biopsies)
3. DRE findings (how the prostate feels when examined by the urologist)

Nerve sparing surgery is not generally suitable for men that have a PSA>10ng/ml or a primary Gleason pattern >4.  For those men with these characteristics non nerve sparing is more a suitable surgical option.

LRP is performed under general anaesthetia (the patient is asleep) and takes around 3 hours to perform. After this the majority of patients spend 2-3 nights in hospital before returning home, in contrast to an average of 5 days for an open radical prostatectomy performed in Australia. Men undergoing LRP will have a catheter (small plastic tube) passed through the urethra (outlet pipe of the bladder- the one you pass water through) that will stay in place for one week. After that time men will return to the hospital for a trial of void. This involves removing the catheter (not painful- sounds worse than it is) and waiting until urine has been passed normally prior to returning home. If you live a long distance from the hospital it is possible to make alternative arrangements.

The advantages of LRP are that of improved visualization, reduced post operative pain, a shorter hospital stay and a more rapid return to normal activity.