Laparoscopic radical prostatectomy

Laparoscopic radical prostatectomy means the surgical removal of the entire prostate and seminal vesicals, even regional lymph nodes if needed, as well as reconnecting the urethra with the urine bladder. Depending on the case, the procedure is done either transperitoneally (LRP) or extraperitoneally (ELRP). Laparoscopic radical prostatectomy is one of the most demanding laparoscopic surgeries in urology, so an experienced team is crucial for a successful outcome. Namely, it is not simply about removing the whole prostate and seminal glands and consequently the oncological outcome, but it is also about retaining the patient’s quality of life, meaning good urinary continence and erectile function.

When is it needed?

Laparoscopic radical prostatectomy is used to surgically treat prostate cancer. In modern urology, it is applied in cases of a localized cancer, locally advanced, and even in oligometastatic cancer – provided that the very strict criteria is met. In cases of localized disease, histologically non-aggressive prostate cancer, it is not necessary to remove regional lymph nodes, and so the surgery is performed using the extraperitoneal laparoscopic technique. In cases of locally advanced or oligometastatic cancer, lymphadenectomy is absolutely necessary. Today’s standard is the so-called extended pelvic lymphadenectomy, which can be done extraperitoneally, and therefore the transabdominal approach (LRP + LIMF) must be used.

How is it performed?

In order to perform laparoscopic radical prostatectomy, we require 5 trocars inserted at the bottom part of the abdominal wall. We get extraperitoneal access using a special technique of balloon dilation that forms an artificial space in front of the peritoneum (the inner membrane tissue of the stomach) where the trocars are then inserted. The inner part of the surgery is much the same as with the traditional approach. After detaching and removing the prostate and the seminal vesicles – and often even a part of the bladder neck – and inserting a urinary catheter, we create a connection between the urethra and the bladder (urethrovesical anastomosis). If needed, we also perform regional lymphadenectomy and remove pelvic lymph nodes. A drainage tube is placed to monitor and control possible bleeding and/or urine secretion. The endoscopic bag containing the tissue is removed through an extended incision made at the one of the trocar incisions. The remaining trocars are removed, and the incisions are stitched up.

Laparoskopska radikalna prostatektomija
Karcinom prostate

What are the possible complications?

In the hands of an experienced surgical team, complications in laparoscopic radical prostatectomies are rare. The most common possible complication is bleeding that might require a blood transfusion. Done transperitoneally, there are also general risks of laparoscopic surgery, such as damages to the large intestine, the rectum, urine bladder, blood vessels, and the ureter. According to Dr. Zupancic’s personal statistical data based on three thousand surgeries performed, these risks are minimal and occur in less than 0.5% of all patients. Approximately less than 0.1% of laparoscopic radical prostatectomies require a conversion to the traditional approach.