What is Radical Prostatectomy?
Radical prostatectomy is the surgical procedure used to treat prostate cancer.
Methods of Performing Radical Prostatectomy
Radical prostatectomy can be performed either through the open method or through the laparoscopic method (with or without robotic assistance).
While the oncological outcomes are the same between the open and laparoscopic methods, laparoscopy has the advantage of:
- Reduced postoperative pain.
- Shorter hospital stay.
- Faster return to normal activities.
- Lower blood loss.
- Detailed imaging of important anatomical structures that control continence and erectile function due to high-resolution optical systems.
For this reason, laparoscopic (with or without robotic assistance) has become the preferred method for performing radical prostatectomy.
Difference Between Laparoscopic and Robot-Assisted Laparoscopic Radical Prostatectomy
Laparoscopic radical prostatectomy requires a high level of laparoscopic skill and experience due to the technical demands of the procedure.
The robotic platform was developed as an aid to surgeons in meeting the high demands of the surgery (robot-assisted laparoscopic radical prostatectomy). There is no difference in oncological and functional results between laparoscopic and robot-assisted laparoscopic radical prostatectomy when performed by experienced surgeons.
The advantage of robotic assistance should be balanced against the disadvantage of the lack of “haptic feedback,” i.e., the sensation of anatomical structures and the higher cost.
The choice between laparoscopic or robot-assisted laparoscopic surgery depends on the surgeon’s laparoscopic skill, experience, and the patient’s preference.
Laparoscopic radical prostatectomies to achieve the expected oncological and functional outcomes require significant laparoscopic skill and experience, as well as a well-equipped center with cutting-edge technology.
For this reason, laparoscopic interventions are performed in a few centers, including the Advanced Laparoscopic and Endoscopic Urology Central Urology at the Lefkos Stavros Clinic. This center performs one of the largest numbers of laparoscopic radical prostatectomies in Greece, ensuring the necessary expertise and guaranteeing the safety and optimal oncological and functional results of the method.
How is the procedure of laparoscopic radical prostatectomy performed?
Laparoscopic radical prostatectomy (with or without the assistance of robotic equipment) is performed through 5 small incisions in the skin through which the optical camera and specially designed laparoscopic tools are inserted.
Radical prostatectomy involves the removal of the prostate gland, part of the urethra, and the reconnection of the urethra with the urinary bladder. In some cases, pelvic lymph nodes are also removed.
After the surgery, a urinary bladder catheter is placed, which remains for 7 days.
At Central Urology, we employ the extraperitoneal approach, which involves performing the procedure without violating the peritoneal cavity, which contains the intestines. This technique has the following advantages:
- Reducing the risk of complications from intestinal injury.
- Rapid restoration of normal intestinal function, allowing for the patient’s speedy discharge from the hospital. The patient’s hospital stay typically lasts only 1 day.
- Reduction of pressure on the patient’s head due to the prolonged Trendelenburg position, where the patient’s head is lowered.
The most significant risks of the procedure
The most significant risks of the procedure are urinary incontinence and erectile dysfunction.
The risk of urinary incontinence and erectile dysfunction after the surgery is due to the close relationship between the prostate and the anatomical structures that control the mechanisms of continence and erection, namely the sphincter and the nerves responsible for erection.
It has been proven that the primary factor in reducing the risk of incontinence and erectile dysfunction after radical prostatectomy is the surgeon’s technical expertise and experience in protecting the sphincter and the erectile nerves.
It is estimated that a center should perform approximately 100 radical prostatectomies per year to be considered a reference center and achieve the correct results.
At Central Urology, we perform approximately 2 to 3 major laparoscopic surgeries every day. This ensures the necessary experience and guarantees safety and optimal oncological and functional outcomes in terms of protecting the erectile nerves and the mechanisms of continence, offering results comparable to those of the largest international reference centers in laparoscopic and robot-assisted laparoscopic radical prostatectomy.
