ANNOUNCER: Prostate cancer is all too common. Almost 200,000 men learn they have it each year. In some cases fighting the disease involves a procedure called a radical prostatectomy.
JIHAD KAOUK, MD: The procedure is to remove the whole prostate gland with an associated adjacent gland called the seminal vesicle together, completely removing the cancer.
ANNOUNCER: Today there is a new type of procedure that is not only less invasive than before but also offers speedier recovery. It's called laparoscopic or "keyhole surgery."
JIHAD KAOUK, MD: It's doing the surgery through small incisions, about one centimeter of a skin incision. We use several incisions, at least three: one for the camera, then two for each hand of the surgeon's instruments. And the whole surgery is done inside the body of the patient himself. And we use a scope that has a camera at its tip and a powerful light source so that we have a good image. We look at a screen while doing the surgery. That usually is a magnified image.
ANNOUNCER: This is a departure from traditional open-type surgery, which requires a large incision and provides a wide open view. How can a surgeon manage this delicate surgery without a "hands-on" approach.
JIHAD KAOUK, MD: The brain can read signals of pressure on the tip of the instruments and then you can know exactly how much pressure you should put, how much tension on a suture line.
ANNOUNCER: With laparoscopy the surgeon can only see what the camera sees, but that doesn't stop them from getting the complete picture.
JIHAD KAOUK, MD: It's not a limitation to be looking precisely and zooming into where you want to work, because you have always the option to zoom out and check the whole field.
ANNOUNCER: While the approach is different, both surgeries do share similarities. Both require general anesthesia. And in skilled hands, each operation will take between two to three hours. And they also share another set of problems.
JIHAD KAOUK, MD: Specific to prostate surgery, one can have urine incontinence and potency issues.
ANNOUNCER: Both surgeries are performed with the best effort to spare damage to nerves that control bladder control and erection.
JIHAD KAOUK, MD: So nerve-sparing surgery is to go in a very close plane to the prostate between the nerves and the prostate gland and remove the prostate without injuring the nerves themself.
ANNOUNCER: Which holds less risk? The jury is still out, although the scales may be tipping.
JIHAD KAOUK, MD: We have 98 percent totally dry with excellent control of urine after surgery as before surgery. And this is as good as the best open surgical results reported. For potency, there is a lot of debate and evolving results in the literature now.
ANNOUNCER: There are some really crucial differences during the recovery period, and that might make a difference to patients.
PATIENT: Less invasive for one thing. Wasn't looking forward to a big scar and healing that probably would have had with the other surgery. Just made more sense that you can get in and out with less pain and less inconvenience for me really.
JIHAD KAOUK, MD: In open surgery, they require more pain killers. That's why they may stay one or two days in the hospital, and that's why the recovery and going back to work may be extended for three weeks to one month.
The first day after surgery is painful. So one should not think that with small laparoscopic incisions there is no pain. It is a major surgery, after all. But after the first day, recovery is very fast. Usually the patients stay in laparoscopy overnight. In open surgery, it may be one or two days.
ANNOUNCER: A shorter hospital stay also means less time in bed, which cuts down on other complications.
JIHAD KAOUK, MD: The earlier the patient is out of bed and back into normal activity, the lower the risk of blood clots.
ANNOUNCER: Of course what all patients really want to know is, "How soon can I be up and running and back to my normal life?"
JIHAD KAOUK, MD: It's much faster in laparoscopy. I would say within two to three weeks, the patient would be back to work in laparoscopic surgery. And that's mainly because the Foley catheter, that is the catheter that drains the bladder, is removed very early in laparoscopy compared to open.
In laparoscopic surgery, we remove the catheter day three to five days after surgery, while in open surgery it takes two to three weeks to remove the catheter.
ANNOUNCER: Even more important than returning to normal activities is the chance to defeat the cancer.
JIHAD KAOUK, MD: This was studied thoroughly, and laparoscopy is as effective as open surgery in controlling prostate cancer.
ANNOUNCER: At one point some patients were not appropriate for laparoscopic surgery. That's no longer the case.
JIHAD KAOUK, MD: We are now accepting patients who, earlier in our experience, we didn't accept, like patients who are morbidly obese or patients who had multiple abdominal surgeries before
ANNOUNCER: Making an informed decision might require doing a little homework.
PATIENT: Web would probably be a good place to start and then find a surgeon or doctor that does this type of surgery and find out his history and his success stories.
ANNOUNCER: Ultimately your doctor can help you in making choices. And now patients have alternatives they once never had.
JIHAD KAOUK, MD: Some people like to go by a conservative, standard way and would say, "I would like to do the open surgery that have been done for the last 30 years." And some people would say, "I'm convinced that science is evolving and we're having new methods that provide better advantages to the patient and I would choose that."