Why choose laparoscopic radical prostatectomy?

In recent years, the incidence of prostate cancer in my country has been increasing year by year. In Western countries, prostate cancer has become the second largest tumor after lung cancer. With the widespread clinical application of PSA screening and other detection methods, the diagnosis rate of early prostate cancer has been greatly improved, and its treatment has become a hot topic in medical research today. Radical prostatectomy is the standard method for treating early prostate cancer.

As early as 1997, there were reports of extraperitoneal laparoscopic radical prostatectomy for localized prostate cancer. In 1999, Guillonneau established a standardized laparoscopic radical prostatectomy. Currently, laparoscopic radical prostatectomy has become a mature treatment method. In developed countries and regions such as the United States and Europe, it is gradually replacing traditional open radical prostatectomy in clinical practice and becoming the preferred method for treating localized prostate cancer. Compared with traditional open surgery, laparoscopic radical prostatectomy has many unique advantages.

(1) Good tumor control. Laparoscopic radical prostatectomy and open surgery have similar efficacy in removing tumors. There is no statistical difference in the positive margin rate and tumor residual rate between laparoscopic radical prostatectomy and open surgery, and the long-term survival after the two procedures is consistent.

(2) Less intraoperative damage and less bleeding. It is reported that the amount of intraoperative bleeding in laparoscopic radical prostatectomy is only one-fourth of that in open surgery. This provides a good visual field for surgery and also reduces the risk of damage to surrounding tissues during surgery.

(3) Quick recovery after surgery. After open surgery, patients often need to have a urinary catheter for about 15 days, while patients who undergo laparoscopic radical prostatectomy can often have the catheter removed about one week after surgery. In addition, laparoscopic radical prostatectomy significantly shortens the average length of hospital stay for patients, alleviating the pain of patients while saving medical expenses;

(4) The quality of life of patients after surgery is less affected. Urinary incontinence is one of the main factors affecting the quality of life of patients after radical prostatectomy. Large-sample clinical studies have shown that the incidence of true urinary incontinence is basically the same between laparoscopic radical prostatectomy and open radical prostatectomy. For the more common postoperative stress urinary incontinence, about 95% of patients can recover to their ideal level 6 months after laparoscopic radical prostatectomy.

In summary, the surgical treatment effect and long-term postoperative complications of laparoscopic radical prostatectomy are similar to those of open surgery, but its fewer perioperative complications and faster postoperative recovery are irreplaceable by open surgery. Currently, laparoscopic radical prostatectomy has been widely used, especially in large medical centers where it has been performed as a routine operation, and the conversion rate to open surgery is only about 2%.