Radical Prostatectomy

The indications for laparoscopic radical prostatectomy are the same as those for open prostatectomy. However, the laparoscopic approach can be more challenging in certain patients, such as those who are obese or who have a large prostate gland or a narrow, deep pelvis. A history of pelvic fracture, abdominal or pelvic surgery, particularly endoscopic or open prostate surgery, and pelvic radiotherapy can also pose technical difficulties because previous modifications of the structures around the prostate can make identification and dissection of anatomic landmarks less clear. In addition, specific precautions are needed because of the potential presence of adhesions from previous intra-abdominal surgery. For example, the surgeon may consider approaching the dissection of the seminal vesicles anteriorly.