Laparoscopic prostatectomy is a minimally invasive surgical procedure to remove the prostate, which is used in particular for locally confined prostate cancer. Unlike open radical prostatectomy, the procedure is performed via several small incisions in the lower abdomen, through which a laparoscope and fine surgical instruments are inserted.
During the operation, the entire prostate, including its capsule, the seminal vesicles and the vas deferens, is precisely separated from the surrounding tissue. The surgeon works with optical magnification provided by the laparoscope, which allows sensitive nerves and blood vessels to be spared. The urethra is severed directly below the prostate and, after removal of the organ, reconnected to the bladder via a fine anastomosis (suture connection).
The aim of laparoscopic prostatectomy is the complete removal of the prostate, including all tumor-bearing parts, in order to achieve a cure for prostate cancer while preserving continence and – in the case of nerve-sparing surgery – erectile function as far as possible.
As laparoscopic surgery does not require a large abdominal incision, it is considered a gentler alternative to open procedures. Blood loss is lower, post-operative pain is usually reduced, and recovery is faster. Thanks to modern laparoscopic techniques, the procedure can be performed either extraperitoneally (outside the abdominal cavity) or transperitoneally, depending on the surgical team’s experience and the patient’s anatomical situation.
Laparoscopic surgical techniques have become the standard in urology and form the basis for modern variants such as robot-assisted laparoscopic prostatectomy, which allows for additional precision.
When is laparoscopic prostatectomy a suitable surgical option for prostate cancer?
Laparoscopic prostatectomy is primarily used to treat prostate cancer when the tumor is locally confined and has not metastasised. It is one of the most common procedures in urological surgery and offers a gentler alternative to open surgery.
Surgery is generally considered for:
- Locally confined prostate cancer that has not yet spread beyond the prostate capsule
- Patients in good general health who prefer surgical treatment
- A desire for radical tumor removal while preserving continence and potency
- Following failure or rejection of other treatments such as radiotherapy or active surveillance
The aim is to completely remove the entire prostate, including its capsule and seminal vesicles, thereby maximizing the chances of recovery. The laparoscopic technique allows even delicate structures such as nerves and blood vessels to be preserved under optical magnification.
In certain cases, surgery may be avoided or a different treatment method chosen, for example:
- Active surveillance for slow-growing, low-risk tumors
- Radiotherapy (e.g. brachytherapy or external beam radiotherapy)
- Hormone therapy for advanced stages
- Robot-assisted laparoscopic prostatectomy as a technically advanced variant
Laparoscopic prostatectomy is generally not recommended if:
- the prostate cancer has metastasised,
- the patient has severe heart or lung disease, or
- the patient cannot tolerate general anesthesia due to other medical conditions.
Procedure for laparoscopic radical prostatectomy
Laparoscopic prostatectomy is performed under general anesthesia. The patient lies on their back with their pelvis slightly elevated to give the surgeon optimal access to the prostate. Special trocars are inserted through several small incisions in the lower abdomen, through which the surgical instruments and the laparoscope are introduced. The laparoscope provides a greatly magnified view of the surgical site, allowing the procedure to be performed with extreme precision and minimal nerve damage.
Once access to the abdominal cavity has been gained, the bladder is carefully detached from the prostate. The surgeon then cuts the urethra below the prostate in order to remove the entire prostate, including its capsule, the seminal vesicles and the vas deferens. Depending on the oncological situation, the lymph nodes in the pelvic area are also removed to rule out any possible tumor metastases.
The urinary tract is then reconstructed: the urethra is connected to the bladder via a fine anastomosis (suture connection). To allow urine to drain after the operation, a urinary catheter is inserted, which is usually removed after one to two weeks.
Laparoscopic prostatectomy is predominantly performed extraperitoneally (outside the abdominal cavity) or transperitoneally (inside the abdominal cavity). The surgical technique used depends on the surgeon’s experience and the patient’s individual anatomy.
During the procedure, the surgical team takes particular care to preserve the nerves and blood vessels responsible for continence and erectile function. This so-called nerve-sparing surgical technique is used primarily in patients with locally confined prostate cancer.
The minimally invasive approach results in minimal blood loss, and the post-operative recovery time is usually significantly shorter than with open procedures. After the operation, the patient usually stays in hospital for a few days and can then gradually resume normal activities.
Schematic illustration of laparoscopic prostatectomy: a camera and instruments are guided to the prostate via small incisions in the skin
Surgical techniques and variants of laparoscopic prostatectomy
Laparoscopic prostatectomy is one of the modern minimally invasive procedures for radical prostatectomy. It involves the removal of the entire prostate, including the capsule, seminal vesicles and lymph nodes. The aim is complete tumor resection while preserving continence and – where oncologically possible – erectile function.
In everyday clinical practice, various surgical techniques have become established, differing primarily in terms of the approach used and the technical complexity involved.
The classic form of laparoscopic prostatectomy is performed via five small incisions in the lower abdomen. Trocars are inserted through these incisions, through which the laparoscope and instruments are manoeuvred.
The procedure can be performed extraperitoneally – i.e. outside the abdominal cavity – or transperitoneally. The advantages include reduced trauma, minimal blood loss and a rapid recovery. This method is particularly suitable for locally confined prostate cancer without metastases.
Robot-assisted laparoscopic prostatectomy represents a further development of conventional laparoscopy. With the aid of a surgical robot system – often the da Vinci system – the surgeon controls the instruments with millimeter-level precision.
The technique offers excellent visibility, finer movements and improved preservation of nerves and blood vessels. It is therefore particularly frequently used in nerve-sparing laparoscopic radical prostatectomy. Studies show that patients often regain their continence and potency more quickly following robot-assisted procedures.
Retropubic radical prostatectomy is an open procedure in which the prostate is removed via an incision in the abdomen above the pubic bone. Despite the larger incision, it is still considered oncologically reliable, but is now increasingly being replaced by laparoscopic and robot-assisted methods.
In perineal radical prostatectomy, access is gained via the perineum between the anus and the scrotum. This method is technically demanding and is rarely used, for example in cases of anatomical peculiarities or previous abdominal surgery.
Endoscopic extraperitoneal radical prostatectomy is a technique in which the prostate is completely removed without opening the abdominal cavity. It combines the advantages of minimally invasive laparoscopy with a rapid recovery and a lower risk of complications.
All procedures have the same aim: to remove the prostate completely and with oncological certainty. The technique used depends on the extent of the tumor, the surgeons’ experience and the individual anatomical conditions.
Laparoscopic prostatectomy is considered a modern, minimally invasive procedure for radical prostatectomy and has significantly transformed the surgical treatment of prostate cancer.
Compared to open surgery, it offers a better view of the surgical field, less blood loss and a faster recovery. Nevertheless, it remains a complex procedure that requires experience and precision.
- Minimally invasive approach: The procedure is performed via several small incisions in the skin, thereby sparing the surrounding tissue and blood vessels.
- Less blood loss: By magnifying the structures in the surgical field, the surgeon can stop bleeding in a targeted manner.
- Faster recovery: Patients are usually mobile after just a few days and can leave hospital sooner.
- Less post-operative pain: Smaller incisions result in less pain and a shorter period of catheter use.
- More precise tumor removal: The magnification (up to tenfold) allows for the precise removal of the prostate, including its capsule and the adjacent seminal vesicles.
- Preservation of continence and potency: The nerve-sparing surgical technique can enable a faster recovery of continence and a lower risk of erectile dysfunction in cases of locally confined prostate cancer.
Despite all the advantages, this is a major operation which – like any surgical procedure – carries risks.
Possible complications include:
- Bleeding and post-operative bleeding during or after the operation
- Infections in the area of the wound or the urinary tract
- Urinary incontinence, particularly in the first few weeks after the procedure
- Erectile dysfunction, depending on the location of the tumor and the possibility of using a nerve-sparing technique
- Narrowing of the urethra or anastomotic problems between the bladder and the urethra
- Thrombosis or embolism as general surgical risks under general anesthesia
In rare cases, an acute complication may require a second operation, for example in the event of anastomotic leakage or post-operative bleeding.
However, with experienced surgeons, the complication rate is significantly lower than with open procedures.
Immediately after the operation, the urinary catheter usually remains in place for around 5 to 7 days, until the connection between the urethra and the bladder has fully healed.
A slight burning or stinging sensation when urinating is normal during this time.
Many patients are able to return to work and resume physical activities after just two to three weeks – depending on the individual healing process.
In the long term, most patients benefit from:
- stable continence within a few weeks to months,
- improved oncological control of the tumor,
- and an overall higher quality of life.
Regular follow-up appointments with a urologist are important to monitor the healing process, detect any potential complications at an early stage and confirm that the tumor is no longer present.
Additional information on laparoscopic prostatectomy
Laparoscopic radical prostatectomy is one of the established minimally invasive surgical techniques in urological surgery. During the procedure, the prostate is completely removed, including the entire prostate gland along with its capsule and adjacent seminal vesicles. Trocars are inserted through several small incisions in the lower abdomen to provide access to the prostate. The laparoscope provides high magnification, allowing nerves and blood vessels to be spared with precision.
The anastomosis between the urethra and the bladder is sutured with fine stitches to ensure good continence and a low rate of urinary incontinence. The sphincter muscle between the bladder and the urethra is also carefully preserved. In many cases, lymph nodes are also removed to improve the oncological outcome.
Experienced surgeons usually perform the operation for locally confined prostate cancer using an extraperitoneal approach. With the robot-assisted laparoscopic variant, such as the da Vinci system, patients benefit from a more precise surgical technique. Studies on the technical aspects and experience with endoscopic extraperitoneal radical prostatectomy show very good functional and oncological outcomes.
Overall, laparoscopic prostatectomy is considered the standard of modern prostate surgery. Patients benefit from a faster recovery, less pain and a more nerve-sparing procedure that preserves continence and potency in the long term.
How exactly does laparoscopic prostatectomy work?
In laparoscopic prostatectomy, the entire prostate, including its capsule and the seminal vesicles, is removed via several small incisions in the lower abdomen.
A laparoscope and fine instruments are inserted via trocars, allowing the surgeon to cut the urethra below the prostate and reconnect it to the bladder after the organ has been removed (anastomosis).
The procedure is performed under general anesthesia and takes an average of two to three hours.
What is the difference between laparoscopic and robot-assisted prostatectomy?
Both procedures are minimally invasive surgical techniques for removing the prostate in cases of locally confined prostate cancer.
However, robot-assisted laparoscopic prostatectomy uses a computer-assisted system (e.g. da Vinci) that transmits the surgeon’s movements and provides highly magnified 3D images.
This allows the surgeon to preserve nerves and blood vessels with even greater precision. Patients often benefit from a quicker recovery of continence and sexual function.
When is a laparoscopic prostatectomy appropriate?
A laparoscopic prostatectomy is particularly suitable when the tumor is locally confined and surgical removal of the prostate offers a chance of a cure.
It is primarily used in patients who have no metastases and for whom active surveillance or radiotherapy does not appear sufficient.
In advanced stages or in cases of severe comorbidities, hormone therapy or radiotherapy may be considered instead.
What are the risks following the operation?
As with any major operation, complications can occur.
These include bleeding, urinary incontinence, infections or temporary erectile dysfunction.
Narrowing of the urethra or problems with the sphincter muscle between the bladder and the urethra are also possible. However,
in experienced urology centers, these risks are low, and many patients regain their continence within a few weeks.
How long does recovery take after laparoscopic prostatectomy?
Patients can usually leave hospital just a few days after the procedure.
The urinary catheter is typically left in place for 5–7 days until the connection between the urethra and the bladder has healed properly.
Mild discomfort when urinating is normal.
Full recovery and restoration of continence can take several weeks.
Consistent aftercare and pelvic floor exercises speed up healing.
Are there different types of radical prostatectomy?
Yes. In addition to laparoscopic radical prostatectomy, there are:
- retropubic radical prostatectomy (open surgery via an abdominal incision),
- perineal radical prostatectomy (access via the perineum) and
- endoscopic extraperitoneal radical prostatectomy (EERPE),
in which the abdominal cavity remains closed.
All procedures have the same aim: to remove the prostate cancer in a way that is oncologically safe.
The surgeon decides which technique to use based on the extent of the tumor and the anatomical conditions.
How does the operation affect continence and sexual function?
Urinary incontinence may occur in the short term after the operation, as the sphincter muscle and surrounding structures are irritated.
Through a nerve-sparing surgical technique and targeted training of the pelvic floor muscles, continence can usually be restored within a few weeks.
Erectile function can also recover after some time, particularly with nerve-sparing procedures and in younger patients.
In which cases is laparoscopic prostatectomy not recommended?
It is unsuitable for metastatic prostate cancer, severe heart or lung disease, or if general anesthesia would be too risky.
In these cases, urologists usually recommend alternative treatments such as radiotherapy or hormone therapy.
Is laparoscopic prostatectomy covered by health insurance?
In Germany, statutory and private health insurance providers generally cover the costs provided there is a medical indication, i.e. confirmed prostate cancer and a justified recommendation for surgery for prostate cancer.
The exact billing may vary depending on the clinic, surgical technique and insurance status.
