Keyhole Surgery for Prostate ... Video Transcript

Participants

Jihad Kaouk MD, Michael Eckstein MD

Summary

Prostate cancer often requires removing the prostate gland. A new technique called laparoscopy uses tiny incisions and a camera to accomplish the operation and allow for a speedy recovery.

Webcast Transcript

ANNOUNCER: Prostate cancer is all too common. Almost 200,000 men learn they have it each year. In some cases fighting the disease involves a procedure called a radical prostatectomy.

JIHAD KAOUK, MD: The procedure is to remove the whole prostate gland with an associated adjacent gland called the seminal vesicle together, completely removing the cancer.

ANNOUNCER: Today there is a new type of procedure that is not only less invasive than before but also offers speedier recovery. It's called laparoscopic or "keyhole surgery."

JIHAD KAOUK, MD: It's doing the surgery through small incisions, about one centimeter of a skin incision. We use several incisions, at least three: one for the camera, then two for each hand of the surgeon's instruments. And the whole surgery is done inside the body of the patient himself. And we use a scope that has a camera at its tip and a powerful light source so that we have a good image. We look at a screen while doing the surgery. That usually is a magnified image.

ANNOUNCER: This is a departure from traditional open-type surgery, which requires a large incision and provides a wide open view. How can a surgeon manage this delicate surgery without a "hands-on" approach.

JIHAD KAOUK, MD: The brain can read signals of pressure on the tip of the instruments and then you can know exactly how much pressure you should put, how much tension on a suture line.

ANNOUNCER: With laparoscopy the surgeon can only see what the camera sees, but that doesn't stop them from getting the complete picture.

JIHAD KAOUK, MD: It's not a limitation to be looking precisely and zooming into where you want to work, because you have always the option to zoom out and check the whole field.

ANNOUNCER: While the approach is different, both surgeries do share similarities. Both require general anesthesia. And in skilled hands, each operation will take between two to three hours. And they also share another set of problems.

JIHAD KAOUK, MD: Specific to prostate surgery, one can have urine incontinence and potency issues.

ANNOUNCER: Both surgeries are performed with the best effort to spare damage to nerves that control bladder control and erection.

JIHAD KAOUK, MD: So nerve-sparing surgery is to go in a very close plane to the prostate between the nerves and the prostate gland and remove the prostate without injuring the nerves themself.

ANNOUNCER: Which holds less risk? The jury is still out, although the scales may be tipping.

JIHAD KAOUK, MD: We have 98 percent totally dry with excellent control of urine after surgery as before surgery. And this is as good as the best open surgical results reported. For potency, there is a lot of debate and evolving results in the literature now.

ANNOUNCER: There are some really crucial differences during the recovery period, and that might make a difference to patients.

PATIENT: Less invasive for one thing. Wasn't looking forward to a big scar and healing that probably would have had with the other surgery. Just made more sense that you can get in and out with less pain and less inconvenience for me really.

JIHAD KAOUK, MD: In open surgery, they require more pain killers. That's why they may stay one or two days in the hospital, and that's why the recovery and going back to work may be extended for three weeks to one month.

The first day after surgery is painful. So one should not think that with small laparoscopic incisions there is no pain. It is a major surgery, after all. But after the first day, recovery is very fast.