The treatment of localized prostate cancer discussed by Mr. Christopher Eden, a recognized expert in prostate cancer and the UK's most experienced surgeon performing laparoscopic radical prostatectomy.

Why Surgery?

'Currently, radical prostatectomy is the only treatment for localised prostate cancer that has shown a cancer-specific survival benefit...in a prospective, randomized trial.'
European Association of Urologists Guidelines on Prostate Cancer, 2008.

Which Surgeon?

The medical literature demonstrates a strong link between surgeon caseload and outcome after radical prostatectomy [Brausi, 2006]. In the bar chart below taken from the British Association of Urological Surgeons database analysis for 2006 I am consultant #71.

Total number of Prostatectomies Reported per Consultant [Graph]

Why Laparoscopy?

Laparoscopy is a technique of performing a surgical operation using instruments inserted through narrow hollow tubes ('ports') rather than through a larger incision, as in traditional surgery. The result is shorter hospitalisation and convalescence, less bleeding and post-operative pain and fewer wound complications.

Ports placed for laparoscopic
radical prostatectomy

Incision for traditional
radical prostatectomy

Although laparoscopy is a type of keyhole surgery, the view obtained is much better than looking through a keyhole. Modern equipment produces a wide, bright, clear and magnified view of the operation. The gas used to distend the abdomen during laparoscopy also greatly reduces bleeding during surgery.

Milestones in UK laparoscopic urinary tract surgery

Although the first laparoscopic operation to remove a kidney (nephrectomy) was performed in the USA in 1991 laparoscopy has been slow to gain acceptance in the UK.

The reasons are that it takes a great deal of time and effort to master this method of operating, and the body of evidence necessary to convince UK urologists to learn this technique has only been present for the past few years.

As a result, few centres in the UK offer laparoscopic procedures but many are training to do so. I undertake over 200 cases a year and regularly train surgeons from the UK and abroad.

1992	First laparoscopic nephrectomy
1994	First laparoscopic pyeloplasty *
2000	First laparoscopic radical prostatectomy *
2001	First radical cystectomy *
	* performed by Mr Christopher Eden

The male urinary tract