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An Interview: Laparoscopic Radical Prostatectomy

Expert Applauds Acceptance of Laparoscopic Surgery for Radical Prostatectomy.

Typically, aspiring surgeons don't mind a little blood. But surgeon Arnon Krongrad, MD still takes pause when he thinks of assisting in his first radical prostatectomy in 1984. He recalls holding large retractors as the urologists made massive incisions. And he remembers a tremendous amount of blood.

This gruesome "open" procedure was unforgettable. Even then, Dr. Krongrad knew there had to be a better way. Years after that first prostate surgery, he became integral in developing and popularizing laparoscopic radical prostatectomy (LRP), a less invasive way to deliver radical prostatectomy.

Now more than 20 years later, Dr. Krongrad shares recent developments as laparoscopic radical prostatectomy gains popularity in the surgical community. Most recently, an American Cancer Society patient guide endorsed the technique as safe and effective, offering benefits over open radical retropubic prostatectomy. Dr. Krongrad recently discussed his journey and laparoscopic radical prostatectomy advancements with Healthy Aging.

What was your impression of laparoscopic radical prostatectomy when you first learned about this technique?

I loved the idea, but I was skeptical of the feasibility. Before laparoscopic radical prostatectomy, we were accustomed to relatively dim lighting and, in some cases, heavy bleeding. In difficult situations, we used our hands for surgical control, putting heavy sponges into the pelvis to control bleeding.

Laparoscopic radical prostatectomy asked us to put away our reflexes and trust that dainty instruments-with better lighting-were sufficient. We had to make a leap of faith in one of the most challenging and subtle operations in abdominal surgery. It was a lot to ask. Still, I formally described the procedure with French co-authors and carried out the first modern laparoscopic radical prostatectomy in the United States in 1999 in a small, private hospital in Miami Beach. This proved laparoscopic radical prostatectomy could be done in an American hospital setting. [you can read the story of Billy Ewing and that first LRP by clicking here] 

What were some of the defining moments in the history of this less invasive procedure?

Initially, the surgical community shared in the skepticism of this new approach. However, a handful of other surgeons began to offer laparoscopic radical prostatectomy. And the insurance community, including Medicare, began to cover laparoscopic radical prostatectomy within the next few years, and the tide started to turn.

A more mainstream event occurred in 2003 that helped popularize laparoscopic radical prostatectomy. That's when Pat Robertson, a former presidential candidate and host of television's The 700 Club, came to me for an laparoscopic radical prostatectomy. Since Pat had numerous options, many noticed when he selected laparoscopic radical prostatectomy. To top it off, Pat had it done in an unknown hospital in the neighborhood of Little Haiti. One week later, he was back on the air, looking joyous, relieved and strong.

Pat said on television that he lost his brother to cancer. I see his broadcast as a selfless and courageous act of public service. It was a catalyst for patients and doctors to seriously consider laparoscopic radical prostatectomy as a treatment for prostate cancer.

What does the future hold for laparoscopic radical prostatectomy?

Eight years after we published the laparoscopic radical prostatectomy technical manual, laparoscopic radical prostatectomy‘s popularity continues to grow. Most recently, the American Cancer Society published a patient guide highlighting laparoscopic radical prostatectomy as a reasonable and effective surgical technique for prostate cancer treatment. As awareness grows, I expect laparoscopic radical prostatectomy will fully replace the open radical prostatectomy.