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    Less Invasive Prostate Removal Appears Safe and Effective

    Radical prostatectomy, the complete removal of the prostate gland, is the "gold standard" treatment when the gland needs to be removed due to cancer. This procedure is done with open surgery, where doctors "open up" the patient to remove the prostate. But urologists in Europe are gaining experience with a less invasive method of completely removing this gland using laparoscopy.

    A laparoscope is an illuminated tube inserted through a slit in the abdominal wall, with an optical system that allows surgeons to view the abdominal cavity. The device is commonly used for diagnosis, and also for sterilization procedures in women. But according to Dr. Guy Vallancien, a urological surgeon in Paris, France, the device can also be used safely and effectively to completely remove the prostate.

    Dr. Vallancien presented the European Association of Urology Lecture at the annual meeting of the American Urological Association in Atlanta last week, illustrating his speech with a video showing highlights of the procedure.

    Because it avoids the blood loss associated with open surgery, laparoscopic radical prostatectomy may be a safer approach, said Dr. Vallancien. Also, because it allows patients a faster and less painful recovery, it may be more cost-effective too.

    With data from over 300 of these operations on men with an average age of 64 and an average PSA of 11 (four is the higher limit of "normal" PSA), Dr. Vallancien reports a high success rate. None of the patients has died, and very few experienced complications. Operating time has become increasingly faster as surgeons gained experience it now takes under two hours.

    One of the big side effects of open prostate surgery is incontinence, and in this regard, said Dr. Vallancien, the laparoscopic procedure is better. Of the 333 men for whom he had data, 58 percent were completely dry one month after surgery, and 89 percent needed no pads at 18 months.

    Impotence is another serious side effect of open surgery. Dr. Vallancien said that potency rates among these men are still being evaluated, but that so far the results are encouraging.

    Although the laparoscopic prostatectomy may be safer, cause less bleeding and pain, allow faster recovery, and maintain urinary function, he did warn his American colleagues that it is not something they can just pick up.

    "It is not easy to learn it is a huge and difficult surgery," Dr. Vallancien emphasized. But in time, this procedure could replace the more costly and risky open surgery usually practiced today.


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