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Prostate Cancer: Laparoscopic Radical Prostatectomy

Laparoscopic radical prostatectomy is a surgical technique used to remove a tumour situated inside the prostate gland or to remove the entire prostate. 

Prostate cancer is a malignant tumour that generally grows on the outside or at the rear of the gland. Sometimes the tumour spreads inside and outside the prostate.  To find out whether the tumour has spread outside the prostate you will have tests such as a CT (computed tomography) scan, a bone scan, a chest X-ray, etc. 

Once it has been established that the tumour has not spread, the patient can be treated using a radical treatment that will consist of one of the following: surgery to remove the prostate, the seminal vesicles and the lymph glands (radical prostatectomy) or radiotherapy, which can be external or via radioactive needles inserted into the prostate (brachytherapy). 

Cancer can cause symptoms such as changes in urinary function, often with lower back pain, sexual problems and even blood in urine or semen.  However, these symptoms are not always indicative of cancer.

Benefits of the treatment

Using a laparoscopic approach avoids the need to make an incision in the lower abdomen and reduces the risks and discomfort associated with open surgery. Patients recover more quickly and can resume their daily activities more easily and quickly. Hospital stays are also much shorter.

Medical-technical description

Radical prostatectomy via laparoscopy is an innovative surgical technique that uses a laparoscope (tiny telescope) to remove the prostate cancer through five small incisions in the abdomen.

During surgery, the prostate gland is separated from the bladder and urethra, which are subsequently joined together again. The prostate is removed through one of the incisions made previously. Normally this incision will need to be made a little longer (3-6 cm) depending on the size of the prostate.

About the operation

The surgery is carried out under general anaesthetic and takes between two and four hours, depending on the characteristics of the patient, the size of the prostate, the shape of the patient's pelvis, their weight and previous abdominal or pelvic surgery. 

The surgery is performed under general anaesthesia and consists of inserting a laparoscope connected to a special camera through a small tube or cannula, which gives the surgeon a magnified view of the patient's internal organs on a television screen. The prostate, seminal vesicles and pelvic vesicles are then removed from the pelvis (obturators on both sides). The bladder and urethra are then sutured together. 

Patients usually have to stay in hospital for between 3 and 5 days.

Before the operation

  • A full study of your medical history to determine the details of the surgery.
  • You will have a blood test, medical examination, chest X-ray and electrocardiogram.
  • You must not eat or drink for 6 hours before your operation.
  • You are advised to maintain sexual relations on the two days prior to the operation to empty the seminal vesicles, which makes the operation much easier.
  • Your intestines will be flushed out before the surgery, either by using enemas (laxatives) or osmotic solutions ingested by mouth.

Post-operative care

  • During the operation you will be fitted with a catheter that will be left in place for between 10 and 21 days. You will be released in hospital with this catheter. Before it is removed you will have a retrograde cystography to check that the urethral-bladder join has healed correctly and that no fluid is leaking outside the bladder. Two days before the catheter is removed and for three days afterwards you must take antibiotics to prevent urinary infection.
  • You will be given an anticoagulant treatment for 15 days after the surgery-
  • You must practice exercises to recover your urinary continence. Follow your doctor's instructions.
  • You will be given means for protecting against urine leaks until you recover urinary continence.

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