Laparoscopic prostatectomy: indications and technique

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Averina Olesya Valerievna, candidate of medical sciences, pathologist, teacher of the department of pathological anatomy and pathological physiology

Prostatectomy is considered a high-tech urological operation, which consists of complete removal of the prostate gland along with the capsule, seminal vesicles, pelvic tissue and lymph nodes.

The need for radical prostatectomy arises in case of serious pathology of the gland - cancer, severe hyperplasia, abscessing prostatitis. The operation is complex and requires the participation of an experienced surgeon, whose technique and skills largely determine the outcome and quality of life of the patient.

The prostate is a small gland of the male reproductive system, located at the bottom of the bladder and secretes a secretion that is part of sperm. It covers the outside of the initial portion of the urethra, so the pathology of the organ is accompanied by dysuric disorders.

The type of surgical technique for prostatectomy depends on the disease and condition of the patient; whenever possible, preference is given to laparoscopy, but such a serious condition as cancer often leaves no choice and forces the surgeon to resort to abdominal surgery.

Indications and contraindications for prostatectomy

Like any other operation, prostatectomy has certain indications and contraindications. The following are considered indications:

• Prostate cancer (the most common reason for organ removal);
• Acute prostatitis with the formation of phlegmon or abscesses in the pelvis;
• Chronic prostatitis with suspected carcinoma;
• Prostatitis with the formation of stones in the gland;
• Severe stages of prostate hyperplasia.

Prostatectomy is a traumatic intervention that requires general anesthesia, so it has contraindications, including the general serious condition of the patient, decompensated pathology of internal organs, age over 70 years, and bleeding disorders. An obstacle to prostate removal can be the inflammatory process in the pelvis in the acute phase, when the risk of infection and postoperative infectious complications is high.

If a patient is taking blood-thinning drugs, surgical treatment can be performed only 1-2 weeks after their discontinuation. If it is necessary to perform a planned prostatectomy, all diseases, if possible, are brought to such a course that the operation will not cause serious complications.

Types of prostatectomy

• The purpose of the operation to remove the prostate is to completely remove the organ with the seminal vesicles, part of the urethra, bladder neck, surrounding tissue and, if cancer is suspected, the pelvic lymphatic system.
• The differences in the techniques lie only in the access through which the surgeon reaches the affected organ.
• Highlight:

• Retropubic prostatectomy;
• Perineal;
• Laparoscopic.

retropubic prostatectomy

Retropubic prostatectomy is performed through the anterior abdominal wall. The surgeon makes an incision from the navel to the pubic junction, enters the abdominal cavity, reaches the prostate, crosses and ligates the vessels and nerves and removes the gland as a single block with the capsule, fiber, and seminal vesicles.

At the end of the operation, the doctor connects the neck of the bladder and the urethra, then sutures the tissue layer by layer. A catheter is installed in the bladder to drain urine, which remains there for up to 10-14 days. During this period, healing will occur at the site of the removed gland, and urine will be discharged through the catheter.

Drains are placed in the pelvis to drain wound fluid.

The operation lasts up to 3-4 hours. It is important to preserve the nerve fibers that provide urinary control and erection. This approach allows this to be done in most patients. If it is impossible to preserve these nerve bundles, various types of plastic surgery are used with the supply of nerve roots from neighboring areas.

perineal prostate removal

Perineal removal of the prostate is carried out by cutting the tissue of the perineum, between the scrotum and the anus.

Through this access, the surgeon removes the prostate gland with seminal vesicles, but this intervention option does not allow preserving the nerves responsible for erection and urinary retention.

The positive side of this method of prostatectomy is considered to be a good cosmetic effect, because the suture in the perineum is not visible to others.

If perineal prostatectomy is performed due to cancer, then there is a need for an additional incision in the abdominal wall to remove the pelvic lymph nodes. The perineal approach is used less and less, giving way to other methods that allow preserving the innervation of the pelvic organs with the least cosmetic defect.

Laparoscopic prostatectomy is successfully used in urological practice. The operation is low-traumatic, but allows you to remove the entire required amount of tissue.

During laparoscopy, the surgeon makes several incisions on the anterior abdominal wall, through which instruments, a video camera, and a light source are inserted.

Controlling the manipulations using a video camera, the surgeon removes the prostate gland, seminal vesicles, and lymph nodes.

All prostatectomy methods require general anesthesia and take from 2 to 4 hours. The operation is completed by suturing the soft tissues and leaving drains in the pelvic cavity. Immediately before surgery, antibiotic therapy is prescribed to prevent infectious complications.

Preparing for surgery to remove the prostate

When surgery is unavoidable, it is important to properly prepare the patient for the procedure to reduce the likelihood of complications and surgical risks.

The majority of patients in need of radical prostatectomy are elderly men suffering from a variety of somatic pathologies - hypertension, diabetes, atherosclerosis, chronic diseases of the bronchopulmonary system, etc.

, therefore, a thorough preoperative examination should be carried out and the treatment of these conditions should be adjusted if necessary.

The examinations required for prostatectomy are carried out on an outpatient basis, usually at the patient’s place of residence. The doctor determines a list of necessary procedures, which may take one to two weeks to complete.

Before the operation:

• General and biochemical blood tests, urine tests;
• Coagulogram;
• Tests for syphilis, HIV infection, hepatitis B and C;
• ECG (always for mature and elderly patients);
• Fluorography or chest x-ray.

If cancer is suspected, a study of the level of prostate-specific antigen is required; if metastasis is possible, bone scintigraphy is required. Usually, by the time preparation begins, the patient has already undergone a prostate biopsy; if not, that is also performed.

To clarify the nature of the pathological process, a digital examination of the prostate, an ultrasound examination of the pelvic organs (with a transanal sensor), CT and/or MRI of the affected area are performed.

When the necessary procedures have been completed, the patient is sent to a therapist, who gives his permission for the operation, taking into account the concomitant pathology. The anesthesiologist, based on the analysis data, determines the type of anesthesia and possible risks.

Having all the examination results and permission for surgical treatment from the therapist, the patient is hospitalized.

Before the operation, some studies may be performed again: ultrasound, coagulogram (especially in the case of previous use of anticoagulants).

The surgeon talks to the patient, explains the essence of the upcoming operation, the possible consequences, and the already informed patient signs his consent to the treatment.

On the eve of the operation, the perineum and abdominal wall are carefully and thoroughly shaved; after six o'clock in the evening, food and liquid intake is prohibited. Before prostatectomy in the evening, it is advisable to do a cleansing enema. On the morning of the intervention, antibiotic therapy is prescribed.

Postoperative period

At the end of the operation, the patient is taken to the recovery room or intensive care unit, where recovery from anesthesia, the condition of the wound, and drainage output are carefully monitored. If circumstances are favorable, the patient is transferred to the urology department on the second day, where the recovery period begins.

Before removing the sutures, the postoperative wound is treated with antiseptics twice a day, the urethral catheter is washed with a furatsilin solution to disinfect and prevent its blockage.

Sutures are removed on days 5-7, drainages are removed on days 4-5 after surgery. The urinary catheter is left in the bladder for up to 2-3 weeks.

This is necessary to restore urethral patency and heal sutures.

Recovery after laparoscopic surgery takes minimal time - up to several days, and with abdominal radical prostatectomy it can reach 2-3 weeks, during which the patient will have to stay in the hospital.

Drug treatment involves the prescription of painkillers, antibiotics, and anti-inflammatory drugs.

The next day after the intervention, food and liquid intake is already possible, early activation of the patient is encouraged - you need to get up and walk around the ward and corridor.

Movement contributes to a faster recovery and the prevention of many complications, including such dangerous ones as thrombosis and thromboembolism.

Prostatectomy may be accompanied by complications, the most likely of which are:

• Bleeding in the pelvis, the prevention of which is careful hemostasis and a Foley catheter installed in the bladder;
• Infectious and inflammatory processes accompanied by fever, pain, and general intoxication. Their prevention is antibiotic therapy, treatment of sutures and catheters with antiseptics;
• Urethral strictures with urination problems, for the prevention of which a good drinking regime is recommended;
• Thromboembolic complications, the risk of which is present in any operation, and to avoid them requires early activation, careful monitoring of blood clotting and even drug correction.

Frequent consequences of prostatectomy include urinary incontinence, impotence and erectile dysfunction. Urinary incontinence can persist for quite a long time and in some cases requires additional plastic surgery.

Serious psychological discomfort in men who have undergone prostatectomy causes impaired potency. Damage to the corresponding nerves during surgery can cause persistent impotence that cannot be corrected with medication, so surgeons try to preserve the nerve endings in the surgical area.

Erectile dysfunction accompanies prostatectomy and can persist for up to two years, and in the case of complete transection of the nerves, the erection is disrupted forever. If the innervation of the pelvis is maintained, the erection is restored within this period, sex is possible after one and a half to two months, and to improve its quality, appropriate medications can be prescribed, for example, Viagra, Cialis.

Already on the second day you need to get up and walk; it is recommended to start eating after the first independent bowel movement. If bowel movements have not recovered by the third day, a cleansing enema is needed.

The diet has some peculiarities after prostatectomy. For three weeks you should avoid eating smoked foods, salty and fried foods, carbonated drinks and, of course, alcohol. The volume of liquid (juice, fruit drink, compote, water or tea) should be about 2-3 liters, but if there are contraindications from the heart or kidneys, then the drinking regime is set individually.

To restore urination and erectile function, it is recommended to perform special exercises to strengthen the muscles of the pelvic floor. These exercises can be obtained from your doctor or rehabilitation specialist. Physiotherapy procedures aimed at preventing inflammatory processes and increasing muscle tone are also possible.

For the first three months after the intervention, heavy lifting and heavy physical labor should be avoided, but you should not limit yourself to walking. It is recommended to wear a special bandage or tight swimming trunks to prevent postoperative swelling and lymph stagnation, especially pronounced after excision of the pelvic lymph nodes.

Reviews from patients who have undergone prostatectomy directly depend on the type of operation. The qualifications of the doctor and the level of the hospital play a significant role. After laparoscopy, the impressions are most positive, which is facilitated by early recovery, and during abdominal operations, possible complications can significantly slow down recovery.

Video: surgery – prostatectomy 1.5 months ago – patient review

Surgery to remove the prostate gland can be performed free of charge or for a fee. In the case of cancer and other severe lesions, treatment is carried out by surgeons and oncologists; hospitalization in a public hospital does not require any costs from the patient and is fully covered by insurance.

If the patient wants to undergo paid treatment, then he should be prepared for the costs. So, an operation in a public clinic will cost 50-70 thousand, and in a private clinic its cost reaches 100-150 thousand rubles.

In addition to paying for the operation itself, which is high-tech and therefore cannot be cheap, treatment on a commercial basis requires the cost of examinations and consultations, and also pays for days spent in the hospital.

Video: types of surgical operations for prostate cancer

Source: https://operaciya.info/urologia/prostatektomiya/

What is laparoscopic prostatectomy

When treating various pathologies in the prostate gland, doctors make every effort to preserve the organ and restore its functions.

However, if this cannot be done and the man’s condition continues to deteriorate, laparoscopic radical prostatectomy is used. This is an operation in which the prostate is completely removed.

We will tell you how to prepare for surgery, why it is dangerous and how the patient should behave in the postoperative period.

Indications for prostatectomy

As of 2018, the only indication for prostate removal is cancer. In this case, the tumor should be located in the gland itself, not affect nearby tissues and not have metastases.

Doctors recommend registering and undergoing periodic examinations. If, based on the results of a prostate biopsy, MRI diagnostics and blood tests for PSA, it is determined that the tumor is not growing, treatment is carried out using conservative methods:

• radiation or hormonal therapy;
• brachytherapy;
• HIFU therapy.

When prostate cancer is advanced, radical laparoscopic prostatectomy is inevitable. In this case, there is a chance to save life, albeit at the cost of loss of reproductive function. For this reason, this operation is more often performed on men over the age of 50-60 years.

Preparation for surgical treatment

Most often, the operation is carried out as planned, so preparatory measures begin in the inpatient department. First, the man is examined, the condition of his body is assessed, and blood and urine tests are studied. This is necessary to identify pathologies and conditions that may interfere with the operation. These include:

• joint prostheses;
• artificial heart valves;
• some chronic diseases;
• allergies to medications;
• presence of implants.

A week before the appointed date, you need to stop taking medications that can affect blood clotting, including Aspirin, Warfarin and Cardiomagnyl. If it is impossible to stop the course of treatment, you should consult your doctor to find an alternative remedy. The drugs are discontinued for 20 days; already on the eleventh day after prostatectomy, their use can be resumed.

Other preparatory activities:

• consultation with an anesthesiologist, choice of anesthesia;
• cleansing enema immediately before surgical treatment;
• shaving the surgical field (abdomen and lower back);
• fasting for at least 12 hours;
• injection of an antibiotic to prevent infection.

It is not recommended to hide any information from your doctor. If there are health problems, or a man is taking medications that are not noted in the medical history, this should be reported to the surgeon.

Progress of laparoscopy

Laparoscopic prostatectomy is performed under general anesthesia and lasts 2-2.5 hours. If you do not go into details that are necessary only for doctors, the course of the operation will be approximately as follows:

1. The surgeon will make punctures in the abdominal area through which special devices will be inserted into the abdominal cavity.
2. A small cavity will be created in the male pelvic area, necessary for manipulation.
3. Under endoscopic control, the surgeon will isolate the prostate and cut it off from the bladder and urethra.
4. The organ along with the seminal vesicles is removed.
5. The urethra is sutured to the bladder.

At the final stage, the patient is given a drainage - a special tube, one end of which is located in the place where the prostate gland was, and the other is brought out. The purpose of drainage is to control internal bleeding and drain accumulated fluid to the outside.

Rehabilitation after surgery

Upon completion of the operation, the man is transferred to the intensive care unit or intensive care unit, depending on the condition. As soon as the anesthesia wears off and the patient is able to remember and analyze information, the doctor will tell you what to do now, what to be careful of, and in what cases to sound the alarm.

During the first 24 hours, doctors and nurses will carefully monitor the patient’s condition. Particular attention is paid to vital signs - pulse, respiration, blood pressure. The presence of pain on the first day is considered normal; it goes away after a day. The same applies to blood discharge from the drainage tube.

After surgery, a man is prescribed the following medications:

• antibiotics;
• anti-inflammatory;
• nutritional mixtures.

You can eat only on the second or third day, depending on how the operation went and what condition the patient is in.

The drainage tube is removed 24 hours after surgery, but this period may be extended if the doctor is concerned about the development of complications. Patients are transferred from intensive care on the second or third day, this period also depends on their state of health and indicators. If the operation is successful, the body recovers quite quickly - after two days the man is allowed to get up and start walking.

A week after surgery, the urinary catheter is removed. In the first days, periodic urinary incontinence and some pain when urinating are possible. These manifestations are considered normal and go away on their own after a certain time.

If there is blood in the urine (pink or faint red color, strange dark flakes), you should inform your doctor about this.

Possible complications

The responsible doctor will warn the patient that there may be complications at first. A man must be prepared for them psychologically, so that if they occur, he does not panic, but informs the doctor about the problem in time.

Laparoscopic prostatectomy can cause the following disorders in the body:

1. An increase in temperature on the second or first day may be accompanied by fever.
2. Internal bleeding (rare).
3. Accidental damage to adjacent organs.

Usually the patient is monitored by doctors. Timely testing, monitoring body temperature and ultrasound of the pelvic organs make it possible to identify complications in time and take measures to eliminate them.

Urinary incontinence, as well as erectile dysfunction, can last quite a long time. In men, these side effects disappear after 2-3 months.

The stitches are removed on day 9-10. At this time, you can already take a shower, but baths and swimming pools, as well as saunas, may be prohibited. This point should be discussed with your doctor. The man remains in the hospital for 10-14 days, after which he is discharged home.

When to see a doctor

In most cases, the body recovers quickly after laparoscopic prostatectomy and there are no complications, so there is no need to bother the doctor. However, a man must monitor his well-being and pay attention to the following signs of violations:

• fever several days or weeks after surgery;
• increasing pain in the perineum, lower back, lower abdomen;
• an admixture of blood in the urine, and in a later period – in the semen.

These are signals that problems have begun in the body - internal bleeding or infection. Don't hesitate to go to the hospital!

If everything went well, you can return to work a month after laparoscopic prostatectomy. Until this time, you need to limit physical activity and not lift heavy objects. To prevent adhesions, you need to walk more.

Surgery using the Da Vinci robot

Laparoscopic prostatectomy can be performed without the use of special equipment, but then the human factor is not excluded - not every surgeon can excise tissue with high precision. Therefore, an alternative to the traditional method is the use of the Da Vinci complex

With the help of robotic equipment, the doctor is able to see the prostate area in great detail and make all movements with instruments, including a scalpel, with a high degree of accuracy. This approach minimizes the risk of developing the complications reported above.

The course of the operation in this case is the same as with the classical approach. A man will be able to get up within a day, and the risks of developing enuresis, internal bleeding and erectile dysfunction are minimal. However, the cost of surgery using a robot is quite high and not every patient can afford it.

Conclusion

Radical laparoscopic prostatectomy for prostate cancer is one of the most effective treatment methods that can save the life of a sick man.

If surgery is performed in a good clinic, especially using a robotic system, the risk of complications is minimal.

However, even in this case, the man must follow the recommendations for the postoperative period and take care of himself.

You might be interested

Source: https://prostatits.ru/oslozhneniya/laparoskopicheskaya-prostatektomiya.html

Laparoscopic prostatectomy operation progress

The prostate gland is the most important organ, but in some cases the only and life-saving solution is its removal. Removal of the prostate (radical prostatectomy) is a surgical procedure that involves the complete removal of the prostate gland (along with the lymph nodes, if necessary).

A healthy male gland looks like an apple, the structure of its tissue is homogeneous, the size of the gland does not exceed permissible limits and does not compress the urinary canal.

Indications

Most often, removal of the prostate is indicated if a person is diagnosed with prostate cancer (much less often in the case of prostate adenoma).

In the early stages, prostate cancer is asymptomatic, later it insidiously disguises itself as urinary disorders characteristic of adenoma, so men often consult a doctor only when the process has spread beyond the prostate gland and metastases have appeared (stage III-IV cancer). There is no need to talk about complete recovery here. A surgical scalpel is used, but removal is carried out mainly to eliminate the obstruction in the outflow of urine.

However, the introduction of a combination of digital rectal examination and PSA (prostate-specific antigen in the blood) determination led to a revolution in the early diagnosis of cancer (at stages I and II).

The growth rate of the indicator and the ratio of bound to free PSA is what helps make a diagnosis and conclude about the advisability of surgery.

Thus, due to PSA diagnostics, the number of cases of detection of localized prostate cancer has increased, long before its obvious manifestations. At this stage, removal of the prostate gland can lead to complete removal of the tumor, with minimal risk of recurrence.

• There are several techniques for performing prostatectomy:
• Open prostatectomyLaparoscopic radical prostatectomyLaparoscopic radical prostatectomy using the high-tech Da Vinci complex
• Let's take a closer look at them.

Open prostatectomy

This is one of the very first methods that was adopted. Removal of the prostate gland is done through an incision either in the lower abdomen (radical retropubic prostatectomy) or between the anus and scrotum (perineal).

How is the manipulation carried out?

Removal of the male gland can be carried out using two methods: open traditional and robotic mini-invasive.

The prostectomy operation involves making an incision about 10 cm long in the lower abdomen, through which the gland is removed. If there are indications for removal of lymph nodes, this type of manipulation allows this to be done.

If possible, the nerve fibers responsible for erection and urinary retention are preserved intact. As a result, the urethra is sewn directly into the bladder, so at first a catheter is installed, which is removed after urination function is restored.

Rehabilitation after the intervention takes about a week.

The second option is used less frequently, because The operation itself does not allow the removal of lymph nodes; in addition, the risk of damaging the nerve fibers responsible for erection increases significantly. A small incision is made in the perineal area, and the prostate gland is removed from behind. However, recovery after prostatectomy is shorter.

1. Today, this technique is giving way to more effective and painless ones, in comparison with which open surgery has many disadvantages:
2. high risk of complications (impotence, urinary disorders, urethral stricture); long recovery period; painful intervention; significant blood loss (compared to laparoscopy).
3. The advantages include, perhaps, only the greater accessibility of the method and a sufficient number of competent specialists in our country.

Laparoscopic radical prostatectomy

It is a minimally invasive method and involves the use of a device – a laparoscope. Today, laparoscopic prostatectomy is the most gentle type of intervention; it can significantly reduce the patient’s hospital stay.

How to cure prostatitis in 2 weeks...

Progress of the operation

Through small incisions in the lower abdomen, a laparoscope equipped with a video camera and surgical instruments are inserted, with the help of which the prostate gland is separated from fatty tissue, ligaments, and surrounding organs, and then removed. The postoperative period is about 5 days, depending on the patient's condition.

Pros and cons of the method

• It is most preferable to perform the operation using the Da Vinci surgical robot, as a highly accurate minimally invasive surgical intervention.
• The advantages of the method include:
• reduced risk of complications compared to open surgery; well tolerated by patients; short recovery period; rapid rehabilitation; low blood loss.
• However, the surgeon’s hands cannot be compared in accuracy to the movements of the robot’s “hands,” therefore, when such consequences of prostatectomy as impotence, incontinence, and relapse of the disease are prevented, the endoscopic method of laparoscopy is significantly inferior to the robotic method.

Laparoscopic radical prostatectomy using the high-tech Da Vinci complex

The first robot assistant, Da Vinci, was designed by American specialists. After a successful operation to remove prostate cancer in 2002, this method was officially launched, and doctors around the world began to master it.

The Da Vinci robot is the eyes and hands of a surgeon.

An indispensable assistant allows the doctor to see the surgical field down to the smallest detail due to the appearance of a three-dimensional, many times enlarged image on the screen, fully control the progress of the operation, and also perform all manipulations as accurately as possible due to greater freedom of movement of the devices and the presence of a filter that suppresses the trembling of the human hand

About the operation

The operation involves making several small punctures into which the working instruments of the robot’s “arm” are placed. With their help, the process is visualized and the affected prostate gland is separated. If necessary, lymph nodes are also removed.

One of the most difficult tasks during a prostatectomy is not to damage the nerves responsible for erection (located on the sides of the prostate) and the muscles involved in the continence mechanism. At this stage, every movement, every move is extremely important.

Whether such consequences as impotence and urinary incontinence will appear depends on how accurately this stage of work is performed.

The prostate is removed, the bladder is connected to the urethra using an anastomosis.

On the first day after the intervention with the participation of the Da Vinci robot, the patient is allowed to stand up. This is a very important advantage if the patient is prone to thrombosis. Early activity reduces the risk of blood clots. Eating is possible (moderate amounts).

Advantages and disadvantages

Of course, this method has many advantages:

minimal blood loss; fewer complications due to the highest precision of execution; excellent tolerability by patients; higher chances of maintaining an erection and normal urination; short postoperative period, rapid rehabilitation.

Disadvantages include cost. Expensive equipment and components are used, and highly qualified surgeons are involved.

Effects of carrying out. Biochemical relapse

It is impossible to absolutely accurately determine the body’s possible reaction to surgery, but a specialist, in most cases, during the examination can with a high probability predict the possible risks of manipulation.

The main danger and insidiousness of cancer is relapse (return of the disease). The main positive effect that can be achieved is complete elimination of prostate cancer when recurrence is excluded.

According to statistics, in 30-40% of cases after removal of the prostate gland, the disease returns, “backs up.”

However, about 75% of patients who have undergone prostatectomy are satisfied with the result and quality of life.

An indicator that a relapse has occurred is the level of PSA (prostate-specific antigen) in the blood. Immediately after prostatectomy it is usually zero, and this is normal.

To eliminate biochemical relapse, various methods are used: observation, hormonal therapy, radiation, or a combination thereof.

Complications

Like most surgical procedures, radical prostatectomy can cause negative consequences. Their presence or absence is largely determined by the skill and experience of the operating surgeon, who controls the progress of the operation. The most common ones are:

impaired potency (from 50 to 90% of cases); urinary incontinence after radical prostatectomy (3-36%); urethral stricture (5-17%)

Less common are complications such as thrombosis of the veins of the legs (occurs in people with a tendency to form blood clots), inflammatory diseases, and intestinal dysfunction.

Rehabilitation

1. In order for final recovery to occur, after surgery you must carefully monitor your health and follow your doctor’s instructions. Here are some simple rules:
2. continue taking antibiotics, if they have been prescribed, in order to prevent infectious complications; drink more fluids (prevents the formation of urethral stricture); do not lift heavy things, limit physical activity, walk more; regularly visit your doctor, inform him about alarming symptoms if they appear ;constantly check the level of PSA in the blood to exclude a relapse; follow a diet to avoid constipation; return to sexual activity after consulting a doctor; perform Kegel exercises to strengthen the pelvic floor muscles.
3. The best remedy for prostatitis...

Source: https://medic-sovet.ru/2017/07/08/laparoskopicheskaya-prostatektomiya-hod-operacii/

Laparoscopic radical prostatectomy

Laparoscopic radical prostatectomy is a minimally invasive procedure for prostate cancer. Like other laparoscopic operations, it is performed with instruments that are inserted through punctures in the anterior abdominal wall.

The diameter of such punctures is from 5 to 12 mm, thus, wounds after surgery heal quite quickly, leaving virtually no scars. In a typical case, 5 trocars are installed: one for the endoscope, the rest for instruments.

It should be noted that at the end of the operation, the prostate is removed in a container through one of the punctures, which has to be expanded for this purpose. If the volume of the prostate is large, then to remove it you have to make an incision several centimeters long.

Progress of laparoscopic radical prostatectomy surgery

The course of the operation: laparoscopic radical prostatectomy generally includes the same steps as the course of the open operation. The peculiarity lies in their technical execution, as well as consistency. The prostate is cut off from the bladder, then the surgeon isolates the seminal vesicles and vas deferens, located behind the gland, and crosses them.

After this, sequential isolation of the prostate gland is performed along the posterior and lateral surfaces with clipping or coagulation of the vessels. At this stage, if this is permissible for oncological reasons and erectile function is important for the patient, a nerve-sparing technique can be used. In this case, the prostate is separated as close to its surface as possible. And the neurovascular bundles running on the sides of the gland remain intact. This manipulation during laparoscopic surgery is technically easier and more accurate than with traditional retropubic surgery, due to the small size of the instruments and magnified optics. In our clinic, to improve the quality of the operation and even more precise tissue separation, we use an Erbe water-jet dissector. Thus, functional results (quality of urinary continence and restoration of sexual function) after laparoscopic surgery are better, without compromising the oncological consequences and safety of the operation.

The last and one of the most crucial moments of the operation is the restoration of the continuity of the urinary tract, or the formation of an anastomosis between the neck of the bladder and the urethra (urethra). During laparoscopic surgery, it is performed under direct visual control due to the ability of a camera with 30° optics to “look” from any side.

Simultaneously with laparoscopic radical prostatectomy , if indicated (depending on the stage of the disease, PSA level, cancer malignancy), extended pelvic lymphadenectomy is performed (removal of tissue with lymph nodes from areas into which lymph drainage occurs from the prostate gland). This manipulation is necessary, since cancer metastases first appear in regional lymph nodes.

Recovery after laparoscopic radical prostatectomy

Recovery after laparoscopic RP occurs quite quickly: within a day after the operation, patients get out of bed and move around the ward. Such early activation is a good prevention of congestive pneumonia, thromboembolism and many other complications that can occur after any surgical intervention.

Video of laparoscopic radical prostatectomy

Source: http://laparo-urology.ru/laparoskopicheskaya-radikalnaya-prostatektomiya

Laparoscopic prostatectomy - removal of the prostate

Prostatectomy is a common operation in urology to remove the prostate gland. This radical measure is necessary primarily for patients facing cancer and organ hyperplasia.  

Appointment with a urologist

Previously, prostatectomy was a complex abdominal operation with a long recovery period, but modern surgical technologies have brought this procedure to a new level of safety. Now, to remove the prostate, a minimally invasive technique with optical control is used - laparoscopy.  

Urologists at the Diana Multidisciplinary Medical Center have extensive experience in treating prostate diseases using various methods. Let's try to decipher medical terms that are complex at first glance and describe the procedure in more detail.

Why do you have to remove the prostate?

Removal of the prostate gland is indicated for patients diagnosed with prostate cancer. The technique is often used for men over 50 years of age who have an enlarged gland. Also, removal of the prostate is a necessity for advanced acute and chronic prostatitis.  

If the urologist chooses this method, it is advisable to give preference to the laparoscopic method of performing the operation. The technique allows you to carefully remove the gland itself, surrounding tissues and seminal vesicles and deal with an abscess or phlegmon, because the surgeon controls every movement visually, looking at the computer monitor.

Laparoscopy

The need to remove the prostate is stressful for a man who faces anxiety and complexes. Therefore, in the initial stages of hyperplasia or prostatitis, the urologist strives to avoid surgery by prescribing drug treatment. In cases where medications do not help, there is no point in postponing prostatectomy surgery, because this is a chance to preserve men’s health.  

How to prepare for laparoscopic and extraperitoneoscopic prostatectomy

After performing a biopsy of the prostate tissue and deciding whether to remove the prostate, the doctor decides on the surgical procedure. The subtleties of preparing the patient for organ removal depend on this choice. Options could be:

• Classic laparoscopy is performed through two punctures in the lower abdomen.
• Extraperitoneoscopic prostatectomy involves extra-abdominal access: surgical instruments and optical equipment are introduced into the patient's body through the intestinal region.

Prostatectomy

Both methods do not require lengthy preparation.

The patient is required to consult with a doctor regarding medications taken, undergo blood tests, a smear, have an ultrasound of the pelvic organs, and limit food intake 12 hours before surgery.

If prostatectomy will be performed extraperitoneoscopically, care should be taken to cleanse the intestines in advance. This is achieved by enemas or taking special laxatives prescribed by a doctor.

After a prostatectomy, a man will have to take antibiotics for a while to avoid infection. This requires testing for sensitivity to antibiotics at the stage of preparation for surgery. It is advisable to conduct such testing in relation to the method of anesthesia.  

How is laparoscopic prostatectomy performed? 

Regardless of the technology chosen, removal of the prostate gland will take about 3 hours. During this time, the surgeon will sequentially perform several stages of prostatectomy:

Anesthesia

The operation is performed under endotracheal anesthesia or combined anesthesia. The patient is completely immersed in sleep and does not feel pain or discomfort.

Anesthesia

Access to the prostate gland 

At this stage, the doctor makes several punctures in the abdominal wall or, after inserting instruments into the intestines, punctures the back of the bladder. In this case, along with surgical instruments, a video camera and lighting equipment are introduced into the operation area.

Direct removal of the prostate 

Having reached the prostate, the doctor carefully removes the organ, seminal vesicles and lymph nodes surrounding the gland. The surgeon sees every movement on the computer screen, which allows minimal trauma to the tissues and vascular walls.  

Creation of an anastomosis

After removal of the prostate, a free space is created between the urethra and the bladder. These organs are combined, creating an anastomosis (connection). The doctor inserts a catheter into this area to remove fluid from the body.

End of operation 

The surgeon removes the instruments. The removed tissue is sent for histological analysis to identify cancer cells. If necessary, the patient receives stitches.  

Laparoscopic prostatectomy is a complex operation that requires the skill and knowledge of a doctor. It is especially difficult for a surgeon when working with patients who have a narrow pelvis, because the space for action in this case is limited.

Questions regarding patient recovery after laparoscopic and extraperitoneoscopic prostatectomy

Patients who are about to have their prostate removed have a number of questions, which were briefly answered by urologists from St. Petersburg.

How long will you have to stay in the hospital?

Unlike abdominal surgery, the patient can be discharged from the hospital the very next day after prostatectomy.

When will the catheter be removed?

With laparoscopic surgery, a man needs to use a catheter for three days. For comparison: abdominal surgery increases this period to several weeks.

Will the potency be maintained?

Doctors make every effort to preserve neurovascular tissue and, as a result, sexual function. If the operation is successful, full restoration of potency may take up to six months. During this period, the patient is prescribed special medications to activate sexual function.

What is the blood loss?

Since the doctor monitors the progress of the operation using a video camera, it is possible to maintain the integrity of large vessels and reduce the risk of bleeding. The average blood loss does not exceed 150 cubic meters. cm, which does not require transfusion.

What complications can develop during rehabilitation?

As after any intervention, the patient may experience pain and discomfort. Possible complications include urinary incontinence. The man will have to use special pads for the first 2-3 weeks, after which control of the bladder returns. If this does not happen, the patient will be prescribed Kegel exercises and additional studies.

Laparoscopic prostatectomy at the Diana Clinic is safe and effective. At the same time, we offer favorable prices for medical services at the European level using innovative equipment.

ONLINE REGISTRATION at the DIANA clinic You can make an appointment by calling the toll-free phone number 8-800-707-15-60 or filling out the contact form. In this case, we will contact you ourselves.

Source: https://medcentr-diana-spb.ru/urologiya/laparoskopicheskaja-prostatjektomija-udalenie-prostaty/