What is Laparoscopic Prostatectomy

Laparoscopic prostatectomy is a surgery to remove the entire prostate gland and seminal vesicles. The surgery is performed using a thin, pencil-sized instrument (laparoscope) with a light and camera on the end to help the surgeon see inside the abdomen.

This surgery may be done to treat prostate cancer or an enlarged prostate gland (benign prostatic hyperplasia).

Laparoscopic prostatectomy is less invasive than other types of surgeries for removing the prostate gland. During this procedure, 4–5 small incisions are made in the abdomen. The laparoscope and other surgical instruments are placed through the incisions and the prostate gland is removed.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding and the risk that you may require donated blood (transfusion).
• Allergic reactions to medicines.
• Damage to other structures or organs, such as the rectum, bladder, or small bowel.
• Blockage in the intestines or bowel.
• Scarring (stricture) that causes problems with the flow of urine.
• Inability to control when you urinate (incontinence).
• Inability to get or keep an erection (erectile dysfunction).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow your health care provider’s instructions about cleansing your bowels.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Practice any breathing exercises as told by your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A tube (Foley catheter) will be inserted into your urethra to drain urine from your bladder.
• An incision will be made in your abdomen at your belly button.
• A laparoscope will be inserted into your abdomen through the incision.
• Four or more small incisions will be made.
• Surgical instruments will be inserted into the incisions and used to remove your prostate and seminal vesicles. Your urethra will be disconnected from your bladder.
• Your urethra will be reconnected to the group of muscles that help push urine through the urethra (bladder neck).
• The laparoscope and other surgical instruments will be removed.
• Your incisions will be closed with stitches (sutures).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV tube. You may be given antibiotics, or medicine to help relieve pain or nausea.
• You will be encouraged to walk as soon as possible. You will also use a device or do breathing exercises to keep your lungs clear.
• You may continue to have a Foley catheter draining your urine. You will be instructed on how to care for this at home.
• Do not drive for 24 hours if you received a sedative.

Summary

• Laparoscopic prostatectomy is a surgery to remove the entire prostate gland and seminal vesicles. The surgery is performed using a thin, pencil-sized instrument (laparoscope) with a light and camera on the end to help the surgeon see inside the abdomen.
• You may continue to receive fluids and medicines through an IV tube. You may be given antibiotics, or medicine to help relieve pain or nausea.
• You will continue to have a Foley catheter draining your urine. You will be instructed on how to care for this at home.
• Plan to have someone take you home from the hospital or clinic.

Laparoscopic Prostatectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Abdominal discomfort.
• Nausea.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Activity

• Increase your activity level slowly. Being active after your surgery is important because it reduces your risk of developing blood clots.
• Get out of bed as much as possible, but do not do activities that require a lot of energy. Walk around as tolerated.
• For the first 10 days after your procedure, avoid:
  • Lifting.
  • Straining.
  • Running.
  • Walking more than a couple of blocks.
  • Driving or riding in a car for long periods of time.
  • Sexual activity.

Diet

• Avoid alcohol and drinks with caffeine for 2 weeks. Alcohol and caffeine irritate the bladder.
• Avoid spicy foods. These can irritate the bladder.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

Bowel and bladder care

• Follow your health care provider’s instructions about caring for your Foley catheter.
• Urinate when you feel the need to. Do not hold in your urine for long periods of time.
• Do not strain to have a bowel movement. Straining increases the chances of bleeding.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures) or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood discharge.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Do coughing and deep breathing exercises as told by your health care provider. It may be helpful to take your pain medicines before doing these exercises.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have redness, swelling, or pain around an incision.
• You have more fluid or blood coming from an incision.
• An incision feels warm to the touch.
• You have pus or a bad smell coming from an incision.
• You have a fever.
• An incision breaks open before or after sutures or staples have been removed.

Get help right away if:

• Your catheter stops draining urine.
• Your abdomen becomes swollen.
• You develop shortness of breath.
• You have a lot of bleeding from your incision.
• You have a high fever that does not go away.
• You develop pain in your chest, back, or abdomen.
• You develop pain or swelling in your legs.
• You suddenly gain weight.

Summary

• After your procedure, it is common to have pain, abdominal discomfort, and nausea.
• Take over-the-counter and prescription medicines only as told by your health care provider. Finish all the prescribed antibiotic medicines, even if you start to feel better.
• Increase your activity level slowly to prevent blood clots.
• Follow your health care provider’s instructions about how to take care of your incisions.
• Get help right away if you develop shortness of breath, or if you develop chest pain.