Techniques to surgically remove the prostate include open surgery, hand-assisted laparoscopic surgery and robot-assisted laparoscopic surgery.

Open surgery

Traditionally, surgeons perform open radical prostatectomies through an incision in the lower abdomen (hence the term “open surgery”). This surgery allows for the removal of your pelvic lymph nodes before your prostate is removed.

Experienced surgeons are able to identify your erectile nerves and separate them from either side of your prostate in order to spare them from damage during the operation.

• This nerve-sparing technique reduces the risk of sexual dysfunction by 50%.
• It can be employed if the size and location of the tumour allow for it: if your tumour is too large or aggressive, the surgeon will not be able to save your nerves.

Advantages of this technique

This operation is available in most hospital centres in Quebec and across Canada.

Disadvantages of this technique

This nerve-sparing technique is not used by all surgeons since it is more complicated and delicate than the traditional method. You should speak to your doctor about the procedure to be used.

Hand-assisted laparoscopic surgery

Instead of a single incision, five or six small ones (about one centimetre in length) are made in the lower abdomen. Long, slim surgical instruments are inserted through these incisions to guide the operation.

• A telescopic instrument called a laparoscope is inserted into the abdomen through a small incision at the belly button.
• A camera attached to the laparoscope allows surgeons to see inside the abdomen and perform the surgery without having to make a large incision.

Advantages of this techniqueWhile this technique generally shortens recovery time, it is not proven to be any more effective than open surgery performed by an experienced surgeon.

• Your hospital stay will be shorter, usually one or two nights compared to 2-4 nights with traditional surgery.
• Recovery is generally faster and less painful.
• This technique causes less blood loss.

Disadvantages of this technique

This technique runs the same risks for incontinence and erectile problems as open surgery.

Laparoscopic prostatectomies have not gained widespread acceptance because they are technically difficult to perform even in the hands of skilled laparoscopic surgeons. Specialized training and equipment are required.

Robot-assisted laparoscopic surgery

In recent years, robotic surgery has developed and become increasingly popular. As the learning curve is faster for robotic surgery than for laparoscopy, this type of surgery is more and more widely used by urological surgeons.

• The movements of robotic instruments are intuitive.
• The surgeon has a 3D‑view of the prostate.
• In addition, robotic instruments have articulated tips which mimic human wrist movements.

Advantages of this technique

While this technique generally shortens recovery time, it has not been proven to be any more effective than hand-assisted laparoscopies or open surgeries performed by an experienced surgeon.

• Your hospital stay will be shorter, usually one or two nights compared to 2-4 nights with traditional surgery.
• Recovery is generally faster and less painful.
• This technique causes less blood loss.

Disadvantages of this technique

• Unfortunately, patients still run the same risk for incontinence and erectile problems as in open surgery.
• There are also economic considerations with robotic surgery—specialized training and equipment are required—and only centres with a high volume of cases can offer this technique.

What is the best technique?

We know that you are faced with a choice between several surgical techniques. Which one is the best? We’re not in a position to say yet. The most important factors are the skill and experience of the surgeon rather than the method used. Therefore, we suggest you talk to your surgeon about his or her experience with the different techniques available. We will discuss this subject a little further on in this page.

Nerve-sparing surgery

Surrounding the prostate are bundles of nerves responsible for erections. When the surgeon removes your prostate, he will try to save these nerves. This is known as “nerve-sparing” surgery.

Whether or not the nerves can be spared depends on how close the cancer is to the nerves. It is difficult for the surgeon to know before surgery if the nerves can be spared. The decision to spare nerves is made once the prostate and the tumour can be seen during surgery.

Success rate

Nerve-sparing surgery is more successful with early stage prostate cancer and for younger, sexually active men.