55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

Name of the Procedure:

Laparoscopy, Surgical Prostatectomy, Retropubic Radical, including Nerve Sparing, with Robotic Assistance

Summary

Laparoscopic surgical prostatectomy is a minimally invasive surgical procedure to remove the prostate gland, typically used to treat prostate cancer. The procedure involves small incisions and the use of a camera and instruments controlled either manually or robotically to excise the prostate, aiming to spare nerves that control urinary and sexual functions.

Purpose

This procedure is performed to treat prostate cancer by removing the prostate gland. The goals are to eliminate the cancer, minimize blood loss, reduce pain and scarring, and preserve urinary and sexual function by sparing critical nerves.

Indications

• Diagnosed prostate cancer
• Elevated Prostate-Specific Antigen (PSA) levels
• Localized prostate cancer confined to the prostate gland
• Patients with good general health and reasonable surgical risk

Preparation

• Fasting typically required 8 hours before surgery
• Medication adjustments may be necessary; anticoagulants and certain blood thinners may need to be stopped
• Pre-operative assessments may include blood tests, imaging studies, and an ECG

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin, lighted tube with a camera) and other surgical instruments or robotic arms are inserted through the incisions.
4. The surgeon locates and carefully removes the prostate gland, aiming to spare the surrounding nerves.
5. The robotic system, if used, allows for more precision and can be controlled by the surgeon from a console.
6. The incisions are closed with sutures or staples.

Duration

Typically takes 2-4 hours, depending on complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Urologic Surgeon
• Surgical Assistant
• Anesthesiologist
• Nursing Staff
• Robotic Surgical Team (if applicable)

Risks and Complications

• Common: Infection, bleeding, blood clots
• Rare: Damage to surrounding organs or tissues, incontinence, erectile dysfunction
• Management: Antibiotics for infection, medications and interventions for clotting or other complications

Benefits

• Effective removal of prostate cancer
• Reduced blood loss and postoperative pain compared to open surgery
• Shorter hospital stay and quicker recovery
• Retention of urinary and sexual function due to nerve-sparing techniques

Recovery

• Hospital stay of 1-2 days post-procedure
• Catheter use for about a week
• Gradual return to normal activities over 4-6 weeks
• Follow-up appointments for monitoring PSA levels and recovery progress

Alternatives

• Traditional open prostatectomy
• Radiation therapy
• Hormone therapy
• Active surveillance for less aggressive cancer
• Pros and Cons: Alternatives may involve longer recovery, different side effects, or less precision in nerve-sparing

Patient Experience

During:

• The patient will be asleep under general anesthesia and should feel no pain.

After:

• Expect some discomfort and soreness at incision sites
• Pain management typically includes prescription pain relievers and over-the-counter medications
• Normal activities can usually be resumed gradually within a month