Minimally invasive surgery is defined as a surgical procedure performed through small incisions -- usually made in the abdominal wall -- the result of which is the least possible damage to organs and surrounding tissue. The general advantages of minimally invasive surgery for patients are minimal blood loss, quicker recovery, and a better cosmetic result.
Using minimally invasive surgery to treat certain genitourinary cancers has become more common in recent years. Our surgeons offer a number of different procedures to treat these cancers, ranging in complexity depending on the location, size, and severity of the tumor.
Minimally invasive surgery is commonly used to treat prostate cancer at Memorial Sloan-Kettering. First performed in 1998, laparoscopic radical prostatectomy is a relatively new minimally invasive procedure to remove the prostate gland. The main goals of laparoscopic radical prostatectomy are to cure the patient and preserve his quality of life: both in the short term -- easier recovery after the operation -- and in the long term -- preservation of continence (ability to control urination) and potency (ability to have an erection).
Nearly half of all radical prostatectomy operations at Memorial Sloan-Kettering each year are performed laparoscopically. This percentage continues to grow every year.
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Laparoscopic Radical Prostatectomy
The surgeon begins the laparoscopic radical prostatectomy by making one incision (one centimeter, or less than half an inch, in length) around the navel in order to insert a thin, lighted tube with a telescopic camera on its tip (called a laparoscope) into the body. The camera projects an extremely clear, highly magnified visualization of the surgical area onto a screen in the operating room, by which the surgical team operates. A harmless gas is introduced into the abdomen to create a space large enough to perform the surgery. The operation is performed with specialized surgical instruments inserted through four tiny incisions in the pelvic area, and the prostate (and, if necessary, lymph nodes and surrounding tissue) is removed.
Since the laparoscopic prostatectomy is performed with special surgical instruments working through tiny incisions, the operation takes slightly longer than more invasive, "open" surgery. Laparoscopic radical prostatectomy typically takes between three to four hours, which is, on average, 15 minutes longer than an open surgery.
Although it is not always possible due to the size and location of the cancer, one of the primary goals of radical prostatectomy is to be "nerve-sparing." This means that the surgeon preserves the web of tiny nerves that control erection and keeps them intact. This extremely delicate and precise technique is made possible with the laparoscopic approach because of the quality of the visualization of the surgical field, due to the magnification of the surgical area and reduced bleeding.
Who Is a Candidate?
Almost all men who are candidates for the traditional, "open" radical prostatectomy are also candidates for a laparoscopic radical prostatectomy. The only exceptions are patients who have had extensive prior pelvic surgery or people with a medical condition that makes the procedure inadvisable, such as a heart condition.
Patients who need surgery to treat prostate cancer frequently have a choice between an open radical prostatectomy and the same procedure performed laparoscopically. Because surgeons generally specialize in either traditional open surgery or minimally invasive surgery, our patients usually choose their surgeon based upon which procedure they wish to have. If the patient is unsure which procedure is most appropriate for him, he will have an opportunity during the initial consultation to learn about each procedure and determine his preference.
If a problem develops at any point during surgery, a laparoscopic radical prostatectomy can be turned into an open procedure and completed that way.
Advantages of a Minimally Invasive Approach
Some of the advantages of laparoscopic radical prostatectomy are:
- less blood loss during surgery
- less pain following the operation
- shorter recovery period
- faster hospital discharge (65 percent of patients are discharged the day after surgery, and 30 percent two days after surgery)
- quicker return to normal activities and work (usually within three weeks)
- better cosmetic result -- four or five tiny incisions versus an eight-inch (or larger) incision from open surgery
Another important advantage of the minimally invasive approach is that for 90 percent of patients the Foley catheter (a thin tube inserted into the bladder to drain urine) can be removed within one week. With open surgery, the catheter usually stays in for two or three weeks following the procedure.
Robotic-assisted Laparoscopic Radical Prostatectomy
Our surgeons can also use robotic assistance to perform the laparoscopic radical prostatectomy. One example is a device that holds the endoscope (a thin, lighted tube with a camera on its tip) during the procedure. This voice-controlled, robotic arm is called "AESOP" (automated endoscopic system for optimal positioning) and helps provide the surgeon with a stable image of the area of operation.
One of the newest technologies for robotic assisted surgery is a machine called the "daVinci system," which is used during a laparoscopic approach. To use this machine, the surgeon is seated at a special computer console, which is positioned away from the patient, and the surgeon sees the area of operation on the console via a magnified, three-dimensional laparoscopic camera. He or she uses joystick controls to remotely guide the surgical instruments and perform the procedure. As the surgeon uses the machine to operate, the surgical team monitors the patient throughout the procedure and can assist at any point.
Investigators are continuing to assess the results comparing the laparoscopic radical prostatectomy and the robotic-assisted approach.
Our Results
Our Publications Visit PubMed for our journal articles on minimally invasive surgery
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Preliminary data suggest that results from laparoscopic radical prostatectomy are comparable to those of traditional open surgery -- in both localized cancer control (measured with surgical "margins," or edge of the tissue removed in surgery) and quality of life issues. Since this procedure is still relatively new, long-term data on progression-free survival and functional results are not yet available.
Our investigators have published a few different studies and review articles that discussed the laparoscopic radical prostatectomy procedure, early results and advantages, and specific techniques.
- In one review, the authors described the widespread implementation of laparoscopic radical prostatectomy in the treatment of prostate cancer -- outlining advantages and early results as compared with those of open surgery. They discussed the evolution of and future challenges for the field of minimally invasive surgery, as new instruments, procedures, and techniques are developed, evaluated, and compared.
Bianco FJ Jr, Guillonneau B. Laparoscopic radical prostatectomy: an evolution in surgery. Minerva Chir. 2005 Oct;60(5):351-62. [PubMed Abstract]
- In another review article, the authors sought to evaluate whether the laparoscopic approach meets long-term and short-term quality standards as compared with results of open surgery. Long-term indicators included oncologic efficacy, and potency and continence rates; short-term indicators included blood loss, hospital stay, postoperative recovery, and rate and severity of complications. They determined that while some biochemical recurrence results are promising, there is not yet enough evidence to answer the question. Future evaluation of the post-learning phase of laparoscopic approach is necessary.
Touijer K, Guillonneau B. Laparoscopic radical prostatectomy: a critical analysis of surgical quality. Eur Urol. 2006 Apr;49(4):625-32. Epub 2006 Jan 31. [PubMed Abstract]
- Another study utilized video review documentation and pathology findings to understand when "positive" margins occur (these margins indicate possible remaining cancer cells following surgery) and how to use this information to improve surgical technique. They determined that quality assurance through video documentation and pathology can help decrease the positive margin rate, particularly in cancer confined to the prostate.
Touijer K, Kuroiwa K, Saranchuk JW, Hassen WA, Trabulsi EJ, Reuter VE, Guillonneau B. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol. 2005 Mar;173(3):765-8. [PubMed Abstract]
Our Team of Experts
Our urologic surgeons who are specialized in minimally invasive surgery are recognized worldwide for their skill and expertise in treating tumors of the prostate.
Select from the list below to learn more about our urologic surgeons and their experience, education, training, board certifications, current publications, and specific areas of clinical expertise.
Last Updated: Jul. 16, 2006
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