Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

iii. Laparoscopic Surgery

In the typical retropubic prostatectomy, a vertical incision about 4 inches long is made in the abdomen. The wide opening allows the surgeon to see all of the internal organs as well as the surrounding blood vessels and nerves. But in the 1990s, surgeons started applying to prostatectomy the same surgical technique that had been used in the more "minor" surgeries such as removal of the appendix or gallbladder.

In laparoscopic surgery, four or five very small incisions—about a half inch each—are made in the abdomen. Through each incision, the surgeon inserts a narrow instrument with tiny cameras and/or surgical tools attached to the end, allowing the surgeon to visualize and operate on the internal structures without cutting open the entire abdomen. Further refinements on this technique led to the development of a robotic interface,where the surgeon maneuvers the robot’s arms, which in turn control the cameras and instruments inserted in the abdomen—effectively performing the operation via remote control.

The benefits of laparoscopic surgery are obvious: smaller incisions and less invasive surgery leads to less blood loss and shorter hospitals stays. However, because this type of procedure is far more challenging than the standard "open" prostatectomy, and the learning curve for becoming proficient is steeper, surgical skill becomes even more important.

If laparoscopic surgery is performed by an experienced, well-qualified surgeon, the outcomes can be as good as traditional open surgery, and, in some cases, even better because it is less invasive. But if you don’t feel comfortable with the procedure, remember that the decision about whether to undergo laparoscopic surgery with or without robotic assistance vs traditional surgery is yours and yours alone.