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Prior to the introduction of the da Vinci™ robot, Tulane Urology performed laparoscopic prostatectomy for the management of prostate cancer. This approach is still used at several medical centers around the world.

The quality-of-life issues are of major concern in the management of prostate cancer today, including duration of post-operative recovery, qualitative improvement in the surgical techniques to provide a more precise anatomic dissection, and preservation of vital structures to decrease the risk of incontinence and impotence. Laparoscopic radical prostatectomy appears to satisfy these important treatment requirements. A few centers are currently proficient in offering radical prostatectomy for management of localized prostate cancer.

Though, the French have amassed the largest experience in radical prostatectomy, there are key centers within the US that are moving ahead with providing this advanced technique for management of prostate cancer .

Briefly:

• the patient is given general anesthesia
• laparascopic trocars or ports are inserted in the abdomen to introduce the laparoscope which is hooked up to television monitors. Through additional ports the surgeon and assistant place small dissecting instruments to precisely view and dissect the prostate.
• Because of the magnification offered by the laparoscope, the dissection is visible more precisely than is usually seen with open radical retropubic prostatectomy.
• The greatest challenge for the urologic laparoscopist is to identify and preserve the neuro-vascular bundle, if a nerve sparing prostatectomy is performed.
• The next challenge is suturing the bladder neck back to the urethra.
• The advantages of laparoscopic prostatectomy is shorter hospitalization, less blood loss, quicker recovery since there is no open incision, shorter duration of the indwelling Foley catheter and less pain.
• The disadvantages are the limited availability of this procedure within the United States. The operative time is longer than the regular open radical prostatectomy.

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