Prostate cancer is a common disease among older men and the second type of cancer with higher incidence among American men. It occurs when there is an uncontrollable growth of the cells in the prostate, a gland sized and shaped like a walnut that is part of the male reproductive system. The gland is located near the rectum, below the bladder and around the urethra, and due to its location, the cancer affects both the reproductive and urinary systems.
There are, however, treatment options for patients who suffer from prostate cancer. Surgery is among them, and it is a common choice for patients whose cancer is still curable and that has not spread outside the prostate gland yet. The main type of surgical procedure for prostate cancer is known as radical prostatectomy, which can be performed as an open or laparoscopic surgery.
Open Approaches to Radical Prostatectomy
A radical prostatectomy consists of the removal of the entire prostate gland as well as some of the tissue around it, including the seminal vesicles. An open radical prostatectomy is the more traditional approach to the procedure, wherein the surgeon makes a single long skin incision to remove the prostate and nearby tissues. There are two main ways to do this operation, which are called radical retropubic prostatectomy and radical perineal prostatectomy.
During a radical retropubic prostatectomy, the incision is made in the abdomen, from the belly button down to the pubic bone, while during a radical perineal prostatectomy, the incision is made between the anus and scrotum (the perineum). In either cases, the patient is asleep under general anesthesia or numbed with spinal or epidural anesthesia. The peritoneal approach is less common since it is more likely to cause erectile dysfunction, but it is also a shorter and faster procedure. During the retropubic approach, the surgeon may also remove some of the lymph nodes if these are affected by cancer.
Laparoscopic Approaches to Radical Prostatectomy
A laparoscopic radical prostatectomy is a more modern and less invasive approach. During a laparoscopic surgery, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. When the surgeon holds the tools directly, the surgery is claled laparoscopic radical prostatectomy. In addition to the surgical instruments, the surgeon also inserts a small camera called a laparoscope in the incision to increase visibility. “This approach to prostatectomy has become more common in recent years,” explain the American Cancer Society. “The most important factors are likely to be the skill and experience of your surgeon.”
However, there is also another approach that consists of the use a robotic interface called the da Vinci system. During a robotic-assisted laparoscopic radical prostatectomy, the surgeon sits at a control panel in the operating room and moves robotic arms, which are used to operate through several small incisions in the patient’s abdomen. “For the surgeon, the robotic system may provide more maneuverability and more precision when moving the instruments than standard LRP. Still, the most important factor in the success of either type of laparoscopic surgery is the surgeon’s experience and skill.”
Benefits and Risks of Prostatectomy
The removal of the prostate through a prostatectomy is known to be an effective method to treat prostate, particularly in cases where the cancer is not metastasized. However, different approaches may result in different outcomes. “Laparoscopic prostatectomy has some advantages over open radical prostatectomy, including less blood loss and pain, shorter hospital stays (usually no more than a day), and faster recovery times (although the catheter will need to remain in the bladder for about the same amount of time). In experienced hands, LRP appears to be as good as open radical prostatectomy, although we do not yet have long-term results from procedures done in the United States.”
Just like in any other surgery, there are possible risks and side effects. In the case of a prostatectomy, the risks during the surgery include reactions to anesthesia, bleeding from the surgery, blood clots in the legs or lungs, damage to nearby organs, infections at the surgery site. These risks are less common in the common in the case of a laparoscopic approach, and are influenced by the patient’s overall health and age, as well as surgical team’s skills. The intestine may also be injured during the surgery, causing abdominal infections, but it is particularly rare. In addition, following the surgery patients often experience side effects, being the two most common urinary incontinence and erectile dysfunction.
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