Explanation of the different types of prostate surgery, including the minimally invasive options, to treat various prostate conditions.

Explanation of the different types of prostate surgery, including the minimally invasive options, to treat various prostate conditions.

Prostate surgery, also known as prostatectomy, is a habitual medical procedure that is performed to treat conditions such as prostate cancer, benign prostatic hyperplasia (HPB) and the obstruction of the urinary tract. There are several types of prostate surgery, each with their own advantages and considerations.

Open Prostate Surgery

A type of prostate surgery is open prostate surgery or retropubic radical prostatectomy. This procedure consists in incision in the lower part of the abdomen to remove the entire prostate gland. Open surgery provides excellent exposure, which allows the prostate gland and surrounding tissues to better remove. This technique is usually recommended in large prostates or when cancer has spread outside the prostate.

Main advantages of open prostate surgery

  • Greater accessibility and visibility during the procedure
  • Effective for larger prostates or advanced prostate cancer
  • Possibility of completely remove the prostate and cancerous fabric

Robotic-Assisted Prostate Surgery

Robo t-assisted prostate surgery, also known as laparoscopic prostatectomy assisted by robot, is a minimally invasive surgical technique that is performed by robotic arms controlled by the surgeon. This procedure consists in making small incisions in the abdomen through which the surgeon introduces specialized tools and a robotic arm equipped with a high resolution camera. The surgeon handles robotic arms from a console, which provides a thre e-dimensional vision of the surgical area.

Main advantages of prostate surgery assisted by robot:

  • Minimum scars and smaller incisions that allow faster recovery.
  • Greater precision and skill of the surgeon
  • Lower blood loss and lower risk of complications

Transurethral Resection of the Prostate (TURP)

Another usual type of prostate surgery is the transureral resection of the prostate (RTUP). The RTUP is a minimally invasive procedure that is carried out with a device called resectoscope, which is introduced through the urethra. The surgeon removes small fragments of the prostate gland to relieve the symptoms of HBP or treat the obstruction of the urinary tract.

Main advantages of RTUP:

  • Effective to relieve urinary symptoms caused by HBP.
  • Shorter hospital stay and faster recovery compared to open surgery
  • Lower risk of bleeding and infection
  1. Open prostate surgery is usually recommended for larger prostates or advanced cancer.
  2. Robot-assisted prostate surgery offers minimal scarring and greater precision.
  3. TURP is a minimally invasive procedure to relieve the symptoms of BPH.

Before deciding on the most suitable type of prostate surgery, it is essential to consult with a healthcare professional who can offer personalized advice based on individual circumstances and medical history.

Types of Prostate Surgery

1. Transurethral resection of the prostate (TURP)

Transurethral resection of the prostate (TURP) is the most common surgical procedure to treat benign prostatic hyperplasia (BPH). BPH refers to non-cancerous enlargement of the prostate gland, which causes urinary symptoms such as frequent urination, weak urine flow, and night urination. TURP consists of removing excess prostate tissue that obstructs the urethra using a resectoscope that is inserted through the penis. This procedure is considered minimally invasive and is usually performed under general or spinal anesthesia.

TURP is very effective in relieving urinary symptoms caused by BPH, with a success rate of approximately 80-90%. It can significantly improve urine flow and reduce the need to urinate frequently. However, TURP can cause complications such as bleeding, infections, retrograde ejaculation (inverted ejaculation into the bladder), and urinary incontinence.

2. Radical prostatectomy

Radical prostatectomy is a surgical procedure used to treat prostate cancer. It consists of the complete removal of the prostate gland, including nearby tissues, such as the seminal vesicles and some lymph nodes. Radical prostatectomy can be performed using different approaches, such as open surgery, laparoscopic surgery, and robotic-assisted laparoscopic surgery. The choice of approach depends on several factors, such as the stage of the cancer, the patient’s general health, and the experience of the surgeon.

  • Open surgery: This traditional method involves making an incision in the lower abdomen or perineum to access the prostate. Provides direct visualization and tactile feedback during the procedure.
  • Laparoscopic surgery: This minimally invasive method involves making several small incisions and using a laparoscope with small instruments to remove the prostate. It offers faster recovery and less scarring compared to open surgery.
  • Robot-assisted laparoscopic surgery: This technique combines the advantages of laparoscopic surgery with the greater precision and dexterity provided by robotic technology.

Radical prostatectomy is an effective treatment option for localized prostate cancer. Its objective is to remove cancerous tissue before it extends beyond the prostate gland. However, like any surgical procedure, radical prostatectomy entails possible risks and complications, such as urinary incontinence, erectile dysfunction, infection and damage to surrounding structures.

In addition to RTUP and radical prostatectomy, there are other types of prostate surgery, such as the transureral incision of the prostate (TUIP), laser surgery and transurethral thermotherapy by microwave (Tumt). These procedures can be suitable for certain conditions or patients and should be discussed with a healthcare professional to determine the most appropriate therapeutic approach.

Open Radical Prostatectomy: an Overview

During an open radical prostatectomy, the surgeon tries to remove the entire prostate gland minimizing damage to the surrounding nerves and vessels responsible for the erectile function. The intervention is usually done under general anesthesia to guarantee the comfort and safety of the patient throughout surgery. Open surgery allows surgeon for a direct visual and tactile evaluation of the prostate gland and surrounding structures, which allows it to make precise and controlled incisions.

The main steps of an open radical prostatectomy include:

  1. Creation of an incision at the bottom of the abdomen
  2. Dissection and separation of the prostate gland of the surrounding tissue
  3. Light and division of blood vessels and ducts that irrigate the prostate
  4. Prostate
  5. Bladder and urethra reconnection
  6. Incision closure

One of the advantages of open radical prostatectomy is that it allows to thoroughly examine the lymph nodes close to the prostate to determine if the cancer has spread. In addition, open surgery provides surgeon for greater control and precision, especially in cases where cancer is large or locally advanced. However, it is important to keep in mind that open radical prostatectomy is an invasive procedure and may require a hospital stay and a longer recovery time compared to the minimally invasive alternatives.

Advantages and disadvantages of open radical prostatectomy
Advantages Disadvantages
  • Direct visualization of the prostate gland
  • Precise removal of the entire gland
  • Possibility of examining lymph nodes
  • Greater control and precision
  • Invasive procedure
  • Longer hospital stay
  • More recovery time
  • Possibility of more postoperative complications

Laparoscopic Prostatectomy

During a laparoscopic prostatectomy, the surgeon makes several small incisions in the abdomen through which specialized surgical instruments are introduced. A laparoscope, a thin tube with a chamber and a light source, which allows to visualize the internal organs is also introduced. Next, the surgeon uses precision instruments to remove the prostate, along with nearby tissues that may be affected by cancer.

  • Laparoscopic prostatectomy offers several advantages:
    1. The smallest incisions leave less scars and reduce the risk of infection.
    2. Minimum blood loss during the procedure helps reduce the need for blood transfusions.
    3. Patient recovery time is usually shorter compared to open surgery.
    4. Pain reduction and postoperative discomfort.
    5. Faster return to normal activities and improve the quality of life.

Important: Laparoscopic prostatectomy may not be adequate for all patients, and the decision on the appropriate surgical approach should be taken in consultation with a specialist. The surgical team will evaluate factors such as the patient’s age, their general health status, the cancer stadium and its individual preferences to determine the most appropriate treatment option.

In summary, laparoscopic prostatectomy is a minimally invasive surgical procedure that offers numerous advantages over traditional open surgery for removal of the prostate gland in patients with prostate cancer. With smaller incisions and lower blood loss, this technique allows a faster recovery time and a better quality of life. However, it is essential that patients consult with a medical professional to determine whether laparoscopic prostatectomy is the right option for their specific case.

Robot-Assisted Laparoscopic Prostatectomy

This innovative approach offers several advantages over traditional open surgeries. First, the use of robotic technology provides a better visualization and allows more precise movements during the procedure. Robotic arms have a greater amplitude of movement than human hands, which allows surgeons to access areas of difficult access with greater skill and precision.

Table: Advantages of laparoscopic prostatectomy assisted by robot

Precision Robotic arms allow precise movements, which reduces the risk of damaging surrounding tissues and nerves.
Minimum healing The small incisions used in laparoscopic surgery give rise to smaller scars compared to open surgery.
Lower blood loss The minimally invasive nature of the procedure entails a lower blood loss, which reduces the need for transfusions.
Faster recovery Patients may experience a shorter hospital stay and faster reinstatement to their daily activities compared to open surgeries.
Lower risk of complications Laparoscopic prostectomy assisted by robot has a lower risk of infection, wound complications and postoperative pain.
  • During the intervention, the surgeon sits on a console and controls the robotic arms with hand and foot controls.
  • The surgical instruments attached to the robotic arms are introduced through small incisions in the patient’s abdomen.
  • Next, the surgeon manipulates the instruments to remove the entire prostate gland, guaranteeing the complete elimination of cancerous tissue.
  • Laparoscopic prostectomy assisted by robot can be performed with or without preservation of the nerves responsible for erectile function.

This technique has revolutionized prostate surgery and is increasingly popular due to its numerous advantages. It allows a more precise and less invasive approach, which translates into better results and a faster recovery of patients undergoing prostate cancer.

Transurethral Resection of the Prostate (TURP)

RTUP is usually recommended to HBP patients, a disease characterized by the enlargement of the prostate, which causes urinary problems such as frequent urination, weak flow of urine and difficulty emptying the bladder. The objective of this surgical procedure is to eliminate excess prostate tissue that obstructs the urethra, thus improving urinary function and reducing associated symptoms.

In the RTUP a specialized surgical instrument called resectoscope is used, which is introduced through the urethra to access the prostate. Next, a wire handle attached to the resectoscope is used to remove obstructive tissue in small segments. This technique allows to remove the prostate tissue in a precise and controlled way, minimizing the damage to the surrounding healthy tissue.

Transurethral Incision of the Prostate (TUIP)

The Tuip procedure consists of the insertion of a fine tube called resectoscope through the urethra to the prostate gland. The resectoscope is equipped with a wire handle that is used to make small incisions in the obstructive prostate tissue. These incisions widen the urethral step and allow urine to flow more easily. Tuip is usually done under general or spinal anesthesia, and most patients can return home the same day or the day after the intervention.

Important information:

  • Tuip is an effective treatment option for men with smaller prostates and milder HBP symptoms.
  • Compared to other prostate surgeries, TUIP has a lower risk of sexual side effects, such as erectile dysfunction and retrograde ejaculation.
  • The recovery period after TUIP is usually shorter than with other procedures, and most patients experience relief from urinary symptoms within a few weeks.

Prostate Laser Surgery: A Precise and Minimally Invasive Treatment Option

Laser prostate surgery is an advanced technique that uses laser energy to precisely remove obstructive prostate tissue while minimizing damage to surrounding structures. This minimally invasive procedure has gained popularity in recent years due to its numerous advantages over traditional surgical methods.

Laser surgery offers several advantages, such as reduced bleeding, shorter recovery time, and greater precision in locating and removing excess prostate tissue. Using the laser, the surgeon can vaporize or enucleate the prostate, depending on the case. This technique significantly reduces the risk of complications such as urinary incontinence and erectile dysfunction, which are more common with conventional surgical methods. Additionally, laser prostate surgery is usually performed on an outpatient basis, allowing patients to return home the same day and resume their daily activities sooner.

Several laser devices are used in prostate laser surgery, each with its own characteristics. One of the most used is the holmium laser. This surgical tool emits a laser beam that is highly absorbed by water, making it an ideal choice for vaporization or enucleation procedures. Another frequently used laser is the green light laser, which offers greater precision and minimal thermal damage. The surgeon decides the type of laser based on the specific condition of the patient and the desired surgical result.

  1. The prostate is a walnut-sized gland located below the bladder.
  2. Laser prostate surgery is a minimally invasive technique to treat an enlarged prostate.
  3. The advantages of laser prostate surgery include reduced bleeding, shorter recovery time, and a lower complication rate.
Laser type Characteristics
Holmium laser Ideal for vaporization or enucleation procedures due to its high water absorption.
green light laser Offers greater precision and minimal thermal damage.

Transperineal Prostate Biopsy: A Comprehensive Guide

During a transperineal prostate biopsy, a specialized needle is introduced through the perineum in the prostate gland in order to collect tissue samples for later exam. This method is preferable to the traditional transrectal method for several reasons. First, it reduces the risk of infection, since the needle does not cross the rectum. Secondly, transperineal biopsy provides better access to the prostate gland, allowing more precise sampling and orientation of suspicious areas.

Main advantages of transperineal prostate biopsy:

  • Lower risk of infection compared to transrectal approach.
  • Greater precision in obtaining tissue samples from specific areas of interest.
  • Less discomfort for patients when avoiding rectal step.

In addition to the important advantages of transperineal prostate biopsy, this procedure also allows the use of the ultrasound guide. Ultrasound helps visualize the prostate gland and guide the needle with precision to the target area, which increases the precision of the biopsy. This method is especially useful when an earlier biopsy has not been conclusive or when there are doubts about the location, size or aggressiveness of cancer.

  1. Prostatic tissue sampling of great precision. In transperineal biopsy, the target area can be achieved more directly, which increases the probability of obtaining a precise tissue sample. The greatest precision helps in the detection and diagnosis of prostate cancer, allowing proper treatment planning.
  2. Lower risk of infection. By avoiding rectal step, transperineal biopsy significantly reduces the risk of bacterial contamination and postproceding infections, improving patient safety and recovery.

Comparison of transperineal and transperine prostate biopsy
Aspect Transperineal prostate biopsy Transrectal prostate biopsy
Risk of infection Minor Elderly
Sampling precision Elderly Minor
Patient discomfort Less Further

Author of the article
Dr.Greenblatt M.
Dr.Greenblatt M.
Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont

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