A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra. There are several forms of the operation: - Transurethral resection of the prostate
- Also called a TURP, this is a cystoscope [A Resectoscope Rather, which has 30 degree of viewing angle, along with Resectoscopy Sheath & Working Element] is passed up the urethra to the prostate, where the surrounding prostate tissue is excised. This is a common operation for benign prostatic hyperplasia (BPH) and outcomes are excellent for a high percentage of these patients (80-90%). A more refined and safer operation is by means of a holmium(Nd:YAG) high powered "red" laser. A related laser procedure for relief of prostatic obstruction utilizes a potassium titanyl phosphate(KTP) laser to vaporize the adenoma. More recently the KTP laser has been supplanted by a higher power laser source based on a lithium triborate crystal, though it is still commonly referred to as a "Greenlight" or KTP procedure. The specific advantages of utilizing laser energy rather than a traditional electrosurgical TURP is a decrease in the relative bloodloss, elimination of the risk of TUR-syndrome, the ability to treat larger glands, as well as treating patients who are actively being treated with anti-coagulation therapy for unrelated diagnoses.3,4
- Open Prostatectomy
- A surgical procedure involving a skin incision and enucleation of the prostatic adenoma, through the prostatic capsule (RPP-retropubic prostatectomy) or through the bladder (SPP-suprapubic prostatectomy). Reserved for extremely large prostates. Both techniques have advantages and disadvantages, with the suprapubic technique being a better choice is patients with prostate volumes that are much larger.
[1] - Laparoscopic Radical Prostatectomy
- a laparoscopic procedure involving four small incisions made in the abdomen is used to removes the entire prostate for prostate cancer.
- Robotic-assisted Laparoscopic Radical Prostatectomy see also [3]
- da Vinci (Robot-assisted) Prostatectomy is the #1 choice for treatment of localized prostate cancer* in the United States:Laparoscopic robotic arms are controlled by a surgeon. The robot gives the surgeon much more dexterity than conventional laparoscopy while offering the same advantages over open prostatectomy: much smaller incisions, less pain, less bleeding, less risk of infection, faster healing time, and shorter hospital stay.[2]. While the cost of such procedures is high, costs are declining rapidly [3]. The manufacturer of the da Vinci Surgical System, used for robotic-assisted prostatectomy, claims that this is now the number one treatment choice for prostate cancer in the United States[.[4]]
- Radical perineal prostatectomy
- an incision is made in the perineum, midway between rectum and scrotum, and the prostate is removed. Radical prostatectomy is one of the key treatments for prostate cancer.
- Radical retropubic prostatectomy
- an incision is made in the lower abdomen, and the prostate removed, by going behind the pubic bone (retropubic). Radical prostatectomy is one of the key treatments for prostate cancer.
- Transurethral plasmakinetic vaporization prostatectomy
- This is also called a TUPVP.
[edit] References - ^ Macaluso JN: Suprapubic Prostatectomy, Chapter 7, Atlas of Surgical Techniques in Urology, edited by E. Douglas Whitehead, p 271-276, Lippincott-Raven Publishers, Philadelphia-New York, 1998
- ^ Center for the Advancement of Health; August 29, 2005; Robot-assisted Prostate Surgery Has Possible Benefits, High Cost [1]
- ^ Cost Analysis of Radical Retropubic, Perineal, and Robotic Prostatectomy; Scott V. Burgess, Fatih Atug, Erik P. Castle, Rodney Davis, Raju Thomas; Journal of Endourology 2006 20:10, 827-830 [2]
- ^ http://www.davinciprostatectomy.com/index.aspx
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