Pre-operative preparation
Before the procedure, the surgeon will interview the patient to explain precautions and answer questions, as well as take a detailed medical history and physical examination. If the procedure requires bowel cleansing, the surgeon will give the patient laxative medication the night before the procedure.
Blood tests are required for all patients. Depending on age and overall health, patients will also need an electrocardiogram, chest x-ray, and pulmonary function tests, and often an echocardiogram or 24-hour ambulatory electrocardiogram in older patients to assess their fitness for the procedure.
Finally, the anesthesiologist meets with the patient to confirm the type of anesthesia for the procedure and to let the patient know about postoperative pain management, such as the use of a PCA (patient-controlled analgesia) pump.
Surgical procedure
During the procedure, the surgeon makes a small hole under the patient’s umbilicus and then inserts an instrument into the abdominal cavity that is connected to a small tube that delivers carbon dioxide. When the laparoscope is in, this gas elevates the abdominal wall and the surgeon is able to better explore the abdominal cavity. The surgeon continues the procedure under laparoscopic guidance, and then the laparoscopic lens transmits a picture of the prostate to a video monitor.
Immediately afterward, a small incision is made near the patient’s belly button, and the laparoscope enters through this incision to connect to the camera. The surgeon can see the images transmitted by the laparoscope on a video monitor next to the operating table.
Before the procedure begins, the surgeon carefully examines the patient’s abdomen to ensure that the laparoscopy is safe for the patient.
- If the surgeon sees scar tissue, infection, or abdominal disease in the patient’s abdomen, the procedure will be terminated.
- If the surgeon feels it is safe to perform the procedure, additional small incisions will need to be made in the patient to allow for abdominal exploration and surgery. Some incisions may even need to be enlarged to allow removal of pelvic lymph node tissue if necessary.
Postoperative considerations
Patients are encouraged to start with a liquid diet and then gradually transition to solid foods. After the patient is discharged from the hospital, a soft diet is consumed, which usually means avoiding raw fruits or vegetables. The dietitian can provide more specific dietary instructions.
Postoperative nausea and vomiting usually occur because of temporary impairment of gastrointestinal function during the anesthesia process. Your doctor will prescribe medications to relieve these symptoms, which will improve in the days following surgery.
From the first postoperative day, patients are encouraged to get out of bed as early as possible and walk as much as possible. After discharge, patients should gradually increase their activity level and should not lift or push any heavy objects or do abdominal exercises such as sit-ups for 6 weeks after surgery.