Introduction

Surgical removal of the prostate gland is one of the most common treatments for men with prostate cancer. Until recently, doctors had two choices on how to remove the prostate:

• Standard surgical procedure (“open” removal): This involves cutting a 4 – 10” surgical incision through which the prostate is removed. The recovery from this surgery is lengthy because of the time the operation takes, the amount of blood loss and the trauma of the procedure.
• Laparoscopic approach: The laparoscope is a rigid tube with a light and camera on the end. This surgery involves making a few small incisions (each less than ½ inch in length) rather than the one large cut made during the open approach. The laparoscope is inserted through one of the incisions and long-handled surgical instruments are inserted through other incisions. While looking through the eyepiece at the end of the laparoscope, the surgeon manipulates the instruments and removes the prostate. Smaller incisions mean less trauma and blood loss, a lower risk of infection, and a reduced recovery time. In 2004, computer assisted robotic surgery became available. This surgery is described in detail in the section titled “Robotic Radical Prostatectomy”.

What Happens During Surgery?

During the radical prostatectomy, your doctor carefully examines all of the organs and tissue in the area of the prostate gland to make certain that there is no cancer located outside the gland. Your doctor may remove the lymph nodes in the region of the prostate and may have a pathologist examine them under a microscope to see if they have any cancer cells in them. If the lymph nodes are free of cancer, your doctor then removes the prostate gland, the part of the urethra that passes through it and both seminal vesicles. Sometimes the cancer has spread to these areas. Once all of the tissue is removed, the urologist will stitch the remaining urethra to the opening of the bladder. A Foley Catheter will be inserted to drain urine after surgery and allow the area to heal. Then the incision is closed. The skin is closed with sutures that dissolve on their own.