Picture someone ice-fishing—cutting a tiny, inconspicuous hole, dropping a line and bringing out a big fish. That’s the idea behind laparoscopic surgery. It’s much less invasive than traditional surgery that involves an incision, and the benefits to patients include shorter hospitalization, quicker recovery time, less postoperative pain, and a better cosmetic result—a few tiny holes, for example, instead of a scar several inches long.

There is a growing movement in surgery to be minimally invasive—to make smaller holes, not big incisions, and, whenever possible, to use the body’s natural passageways, such as the urethra, to reach internal organs. One doctor describes it as “surgery through telescopes.” (The concept itself is not new; use of the endoscope as a means of exploring the body dates back to the turn of this century.) This is the thinking behind the laparoscopic techniques to reach the pelvic lymph nodes in men with prostate cancer.

A man is diagnosed as having early-stage disease. Because there’s no evidence that the cancer has spread, he’s a candidate for curative therapy— surgery or radiation. But as we know, unfortunately, sometimes cancer has indeed spread, in tiny amounts, to the lymph nodes.

So: Is the cancer really localized? For many men who undergo radical prostatectomy (the retropubic procedure), this question is answered before surgery, for others, it’s answered on the operating table. Before even touching the prostate during a radical prostatectomy, the surgeon removes the patient’s pelvic lymph nodes and sends them to pathology, where sections of the nodes are frozen and examined for cancer. If widespread cancer is found, the surgeon doesn’t remove the prostate because it wouldn’t do any good. But the man still must spend several days in the hospital to recover from the incision.

For this and other reasons, an increasing number of men are undergoing laparoscopic pelvic lymphadenectomy (dissection of the lymph nodes) as a means of staging prostate cancer. It has minimal side effects, a brief hospital stay (one or two days), and men can go back to work in one to two weeks. Some men are even having this done as outpatients.


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