What is a Laparoscopic Radical Prostatectomy?

A laparoscopic prostatectomy is a minimally invasive surgical procedure for removing the prostate gland.

Why is it necessary?

If you have cancer of the prostate that has not spread to any other parts of the body, the aim of the operation is to remove the prostate gland and to prevent the risk of cancer spreading.

What to expect during your pre-operative consultation.

Your surgeon will:

• review your history
• review your medical records
• PSA (blood result associated with the prostate gland to determine stage of prostate cancer)
• review X-rays previously carried out

You will undergo a full physical examination followed by a discussion of treatment options available to you.

What preparation is needed?

It is important for you to understand how and why the operation is being done.  You need to be ready for a three to four day stay in hospital, but this can vary depending on the individual.

You will be up and about a day or two after the operation. Allow a period of four to six weeks for convalescence, at home before you get back to your usual activities.

If you are a smoker it is helpful if you can stop a few days before you come into hospital. Advice can be offered, e.g. smoking cessation or quit smoking helpline number – (0191) 219 5111.

A routine blood and urine test will be required and also possibly a heart tracing and chest x-ray to make sure that you are fit for the operation. These are normally done in the pre-admission clinic, prior to your operation.

You will come into hospital the day before your operation and be seen by the nursing and medical staff on the ward.

The anaesthetist will explain what will happen when you are put to sleep.  Elasticated stockings will be provided to prevent clots forming in the veins of your legs.  You will be given a daily injection to slightly thin your blood. 

Before surgery you will be seen by a continence nurse, who will advise you on carrying out exercises to strengthen the urinary sphincter muscle. This is because following surgery urinary incontinence can occur.  This often improves over time with regular exercises.

On the morning of the operation you will change into a hospital gown and be taken to the operating department on your bed or on a trolley. The anaesthetist will put you to sleep usually by an injection through a venflon in your hand.

How is the operation done?

The first part of the operation is to give you an anaesthetic (put you to sleep) so that you will not be aware of anything whilst the operation is being performed. The operation can take 4-6 hours but can vary depending upon the individual. Five very small cuts (approx. 0.5-1cm) are made into your stomach to perform the operation. Through these small cuts a telescope and dissecting tool are used to separate the prostate gland and vessels from the urethra (water pipe) and the bladder.

Once the prostate gland is free from the bladder, rectum and water pipe, it is placed in a bag and removed through one of the cuts.

The bladder is sewn back to the water pipe to restore continuity of the urinary tract.

A tube (catheter) is placed into your bladder to allow urine to drain whilst you recover from your operation. The urine may have blood in it but this is normal and will clear in a day or two.

You may also have a wound drain in your stomach to drain away any blood. This will be removed when there is little or no fluid draining from it which is a minor procedure carried out on the ward by a member of the nursing staff.

You will wake up in the recovery area in your bed. When the nurses are happy with your condition a nurse from the ward will take you back to the ward.

For the next 24 hours, you will have a drip in the back of your hand. For the first few hours we can give you fluids through the drip until you are drinking. While you are recovering from the anaesthetic, you may feel sleepy or ‘groggy.’ There may be some pain. We will give you painkillers to help with this, either with tablets or through a drip as patient controlled analgesia (PCA).  As the name suggests, you can control the amount of pain reliever you receive.  A nurse will show you how to use this.

Minor shoulder or stomach pain can be experienced for up to two days following surgery. This is due to the gas used to inflate your stomach during surgery. Patients often describe this as a “wind like” pain.

You may feel sickly following your operation but medication can be provided to help with this.  Everyone recovers at there own rate. If you are comfortable and do not feel sickly you will be offered food and drink.

The tube (catheter) will remain in your bladder when you are discharged from hospital, normally 4-5 days after the operation.  A small urinary leak can occur at the connection between the bladder and the water pipe. This can take from a few days to a few weeks to heal.

You will need to return to hospital in about four days. An X-ray will be performed to check for this leak. If there is no leak the catheter will be removed.  However if a leak shows up you will return home and be re-admitted in further two weeks at which time the catheter would be removed.

What problems can occur?

You may experience some pain and discomfort, this will settle and painkillers are available to help reduce this. If you are in good health there is only a small risk that the operation and anaesthetic will affect your health in any way (Less than 1 in 1000).

If you do have other health problems such as a bad chest or angina then the risks are slightly higher, but precautions will be taken.

Bladder spasms are commonly experienced as a moderate cramping sensation in the lower stomach or bladder. If this is severe medication can be provided.  Impotence can occur – just as it can with open surgery. A nerve sparing technique is attempted during surgery unless there is obvious involvement of the nerve tissue with the cancer.

The return of erectile function following surgery is dependent on the age of the patient, degree of pre-operative sexual function, technical precision of the nerve sparing technique and time.

Once the catheter is removed some patients may have difficulty in holding on to their urine. This is because of a urinary leak which normally settles in about 3 – 6 months in the majority of patients.

The urologist performing your operation will tell you that there is a very small risk of having to perform open surgery if there are any difficulties.

Are there any alternatives to this surgery?

The alternatives are conventional open surgery or radiotherapy.  No data is available to show that one option is better than the other. There is no
reliable data available as yet to suggest whether surgery or radiotherapy improve survival rates.

What are the benefits?

A shorter stay in hospital and early return back to normal activities.

What can I do when I get home?

Take it easy and build up your strength gradually over four to six weeks.  Start with short walks and gentle exercise until you are fully back to normal.

Try to eat a healthy diet with plenty of fluids, fresh fruit and vegetables.  These are important to keep your bowels regular as this operation can make your bowels “lazy” for a few days.

Avoid heavy lifting, strenuous exercise and heavy housework during this period.  Once you feel that you are back to normal it is safe to do house hold tasks and to drive. If you work it depends on how you feel and the type of job that you do, but four to six weeks convalescence is recommended.

A review appointment for twelve weeks will be arranged to check on your recovery from the operation.

If you have any problems following your discharge from hospital you can contact your GP for advice.  A letter will be given for your GP when you leave the ward. A district nurse will be asked to visit you at home to check that your stomach wounds are healing.

The nurse will also continue giving you your blood thinning injections for up to 10 days following the date of your surgery.

How can other questions be answered?

It is very important that you are happy to go ahead with your operation the best place to ask questions, is during your clinic visit. In the pre-admission clinic you can speak to a nurse or a doctor who will be happy to help. The consultant or a member of their team will see you when you come into hospital to answer any further questions.

Final word

Most peoples' stay in hospital is straightforward. We hope that this gives you the information that you need. Do not hesitate to talk to a nurse or doctor if you have any questions or worries by contacting Ward 1 on (0191) 213 7001.