The Laparoscopic Radical Prostatectomy

What is a laparoscopic radical prostatectomy?

Laparoscopy is surgical procedure in which a rigid scope, with a camera attached, is inserted into the abdomen through a small incision.

Laparoscopic radical prostatectomy (LRP) is a minimally invasive radical prostatectomy.  The LRP and open radical prostatectomy are identical with respect to excision and reconstruction.  During both procedures, the entire prostate and seminal vesicles are removed along with lymph nodes if indicated, and the urethra is attached directly to the bladder.   

During the LRP, the surgeon makes five entry sites, two each on both sides of the lower abdomen and one below the navel.  The incisions are between 5mm (approximately 1/4 inch) and 1cm (approximately 1/2 inch) each and are used for the introduction of surgical instruments.  The surgeon inserts a laparoscope through the incision beneath the navel.  The laparoscope is used to guide the operation.  The scope provides uniform lighting within the narrow male pelvis and transmits dynamic, magnified images to a video monitor that can be simultaneously viewed by the surgeon and operating team.   These images enable the surgeon and the operating team to have identical and precise views of the operative field.  The surgeon has greater control of the anatomy because the laparoscope offers a 15x magnified, well-illuminated view of the operative area.   This combination of good lighting, modern optics, magnification and finer instruments makes the LRP a relatively bloodless, highly controlled, coordinated and elegant operation.

The procedure usually takes between 3 to 4.5 hours and the average hospital stay is two days; however, many patients may be able to go home after 24 hours.  Because the improved visualization of the operative field allows a more precise operation, catheters may be removed in as few as 4 days.  The incidence of scarring at the anastomosis of bladder and urethra is significantly less with the laparoscopic approach.  Bleeding is greatly minimized with only 1% of patients requiring transfusions versus 20% in an open operation.

What is prostate cancer?

Prostate cancer is the most common non-skin cancer in the United States.  It is relatively slow growing and is second only to lung cancer with respect to cancer-related deaths among men in the United Sates. 

How does the prostate gland function?

The prostate is a walnut-sized gland positioned between the urinary bladder and the pelvic floor.  It is wrapped around the urethra and is attached to the seminal vesicles.  The prostate’s main purpose is to produce fluid for semen. 

What are the symptoms of prostate cancer?

There are few symptoms during the early stages of prostate cancer.  Prostate cancer is most commonly detected through screening tests such as the prostate specific antigen test (PSA) and digital rectal exam. However, some symptoms reported include: a need to urinate frequently; difficulty starting urination; an interrupted flow; painful or burning urination; difficulty in having an erection; painful ejaculation; blood in urine or semen; and, pain or stiffness in the lower back.

What is a PSA Test?

The prostate produces a protein, known as prostate-specific antigen (PSA).  The concentration of PSA in the blood provides an estimate of the risk of having prostate cancer.  PSA is not a diagnostic test; a prostate biopsy is required in order to diagnose prostate cancer.

What are the treatments for prostate cancer?

Treatment options may include one or a combination of the following: surgery, radiation therapy, hormone deprivation therapy, chemotherapy, dietary changes and herbal supplements.

What is a nerve sparing prostatectomy?

A nerve sparing prostatectomy is employed in an attempt to preserve a man’s erectile function.  It is dependent upon the extent of the cancer and whether the patient was potent prior.

Can nerve sparing be performed?

The nerves responsible for erectile function travel within the investing fascia of the prostate.  The magnification and improved lighting of the laparoscope makes identifying the neurovascular bundles more precise and may offer improved outcomes with regards to preserving erectile function.

Who is a candidate for LRP?

For the most part, any patient who is a candidate for open radical prostatectomy is a candidate for LRP.  However, obesity or certain prior abdominal surgeries may contraindicate a laparoscopic approach.

How is prostate cancer graded and staged?

Prostate cancers are described by two characteristics, grade and stage, which are used to assess the potential behavior of a cancer.  Tumor grading is a description of the appearance of the cancer cells and is assigned by the pathologist.   It is a property of cancer independent of tumor location. The most common form of prostate cancer grading is the Gleason grading system.   The Gleason score, which is the sum of the two most prevalent patterns of prostate cancer cells detected by the pathologist, ranges from 2 (least aggressive) to 10 (most aggressive). The TNM staging system is the most widely used system in the United States for staging prostate cancer.  Tumor staging describes the extent of growth of the primary tumor (T stage); the absence or presence of spread to nearby lymph nodes (N stage); and, the absence or presence of distant spread, or metastasis (M stage). Stage is assessed by various means, including physical examination and bone scans.  

Are the doctors certified by the American Board of Urology?

Yes.  Both Dr. Colagioivanni and Dr. Olsson are diplomats of the American Board of Urology.

Dr. Olsson received his medical degree from Boston University School of Medicine in 1994 and completed his internship and residency at Yale-New Haven Hospital in New Haven Connecticut.

Dr. Olsson completed a Fellowship in laparoscopic oncology with Dr. Claude Abbou, Chef de Service, Service d’Urologie at the Hopital Henri Mondor in Creteil, France.  Dr. Abbou is one of the pioneers of laparoscopic prostate surgery.  In addition, Dr. Olsson is a member of the American Urological Association and the Rhode Island Urological Society.

Prior to relocating to Rhode Island and joining Consultants In Urology in April 2004, Dr. Olsson worked for a general urology practice in White Plains, New York for three years.  He was a member of the medical staff at Columbia Presbyterian Medical Center, where he also served as an Assistant Professor of Urology. 

Dr. Olsson has over 4 years of experience performing both laparoscopic radical prostatectomies and robot assisted (DaVinci system, Intuitive Surgical) prostatectomies.  Dr. Olsson, with Dr. Colagiovanni assisting, performed the state’s first laparoscopic radical prostatectomy at Our Lady of Fatima Hospital in September 2004.

Dr. Colagiovanni received his medical degree from Tufts University School of Medicine in Boston, Massachusetts in 1989.  He completed his internship and residency at Brown University School of Medicine in Providence, Rhode Island.

Dr. Colagiovanni is a member of the American Urological Association and the Rhode Island Urological Society.

Dr. Colagiovanni is the founding partner of Consultants In Urology, Inc. Prior to establishing the group in February 2000, Dr. Colagiovanni worked for a general urology practice, also located in Rhode Island, for five years, concentrating on minimally invasive stone treatment and the treatment of kidney, bladder and prostate cancer.