Keyhole Surgery

Declan Cahill describes experience gained in Paris

Laparoscopic radical prostatectomy (LRP) is the removal of the prostate using keyhole surgery.  The small access sites through the abdominal wall afford patients a procedure with a low complication rate and an accelerated return to normal activity.   Importantly this is not at the expense of cancer clearance or the patient's functional capacity post-operation.  The views under significant magnification allow more precise surgery of the prostate, neurovascular bundles and urethra.  This translates into less blood loss, better negative margin rates (cancer clearance), preservation of potency (erections) and, probably, better continence.  It is an important and worthwhile addition to the selection of treatments for clinically localised prostate cancer from which patients may choose.

'a lifetime experience for many surgeons'

This is technically challenging surgery.  Sufficiently intense training in this procedure is not available in the UK.  The premier centre for this operation is Institute Montsouris in Paris where LRP was developed, standardised and popularised by Professor Guy Vallancien and his team.  Thanks to the generous support of the Prostate Research Campaign UK, I was able to spend 6 months dedicated to learning this operation 5 days a week.  This was a recipe for success.

The backbone of my training in Montsouris was pelvitrainer work every day, Monday to Friday.  This involves performing laparoscopy in a small wooden box.  I carried out procedures to reconnect simulated severed urethras, using segments of expired dacron vascular grafts that had been scrounged from various London Hospitals.  This gave me the dexterity and hand/eye coordination to operate on people, and made laparoscopic suturing second nature.

It is perceived to be a very difficult procedure.  I do not believe this is entirely true.  Yes, it has proved beyond many surgeons that have tried to take it up, and has deterred others.  However, this is due to inadequate opportunities for training in this country and embarking on this venture unprepared.  With training I think LRP is very realistic.  During my time at Montsouris there were 250 prostatectomies performed.  This is a lifetime experience for many surgeons.  This large volume of work allowed me to become experienced in a short time, see most of the possible complications, learn how to avoid them or manage them efficiently so that they did not translate into patient harm.

I have had an invaluable 6 months of training.  In this country special experiences such as this are made possible thanks to organisations such as the Prostate Research Campaign UK and I am extremely grateful to them.

Prostate cancer is my special interest and by undertaking this fellowship I have greatly strengthened the service I can provide my patients.  They will now have increased choice and security in the knowledge that I have been properly trained.

On my return to the UK I am taking up a consultant post at Guys' and St Thomas' NHS Trust and will be utilising my new skills in this area.  Once the service is established I hope to be able to train other surgeons in this technique.