Leonardo da Vinci and the surgeon Christopher Eden have much in common: both dextrous, both have had an interest in flying machines, both made names for themselves while still young and both have had an interest in anatomy and the arts.

There is, however, a fundamental difference in their interests. Leonardo produced his famous atlas of anatomy, so intricate, detailed and painstakingly drawn that any medical student would learn from it, but unfortunately he left one organ out: Leonardo’s male pelvis didn’t contain a prostate. Eden, on the other hand, spends much of his days thinking about prostates, and is becoming famous for his knowledge of the gland. Six years ago he became the first surgeon in the UK to perform a radical prostatectomy through keyhole surgery. He is now doing nearly 250 a year.

Laparoscopy — keyhole surgery — enables doctors to operate within the cavities of the body, including the abdominal cavity, without making wide incisions. It involves inserting tiny, precise instruments, together with cameras and lighting, through narrow hollow tubes known as ports — as in portholes on a ship — introduced through small incisions.

The cavity is distended with gas pumped through the ports, which allows the surgeon to obtain a good view. Even though the surgeon can’t rummage around and feel the tissues with his hands, the cavity is clearly lit, well magnified and the surgeon is able to obtain an excellent picture of his patient’s internal organs, arteries, veins and nerves. This more than compensates for loss of touch. The fine instruments allow the surgeon to manipulate tissue with great precision and, surprisingly, once experienced in laparoscopic surgery, the feel through the instruments allows the doctor to detect the nature of any tissue they are cutting or manipulating. When some tumours are cut, the knife transmits a gritty sensation, rather like cutting a pear.

Laparoscopic surgery didn’t really take off until the early 1990s, when it became a popular way of removing the gallbladder. Eden carried out the first radical prostatectomy by keyhole surgery in 2000.

Unfortunately, when experts compared laparoscopy to standard radical prostatectomies, the time taken by each laparoscopic operation persuaded experts to conclude that the advantages of keyhole surgery didn’t outweigh the disadvantages of the standard radical.

Eden has changed this. Since 2000, he has performed 600 prostatectomies, as well other laparoscopic urological procedures (at the Department of Urology of the North Hampshire Hospital in Basingstoke).

Whereas the first operations could take up to nine hours, Eden’s now take on average under 2½ hours. In a head-to-head trial in which laparoscopic prostatectomy was pitted against standard radical prostatectomy, laporoscopic techniques would probably win.

This is good news for the increasing number of comparatively young patients with cancer of the prostate. Fifty years ago it was almost unheard of for 40-year-olds to develop the disease.

The overall increase may be related to more men living longer, but why younger men should be developing it in greater numbers is not clear. However, it’s assumed to be environmental factors, possibly richer food, more fat or a change in sexual mores, with more partners and an earlier start.

Eden was saying that he now regularly sees men in their late thirties. Fortunately, if they are operated on early and with laparoscopic surgery, there is not only every reason to suppose that the cancer has an excellent chance of being eradicated, that the patient will be back at work within two or three weeks, but there will also be a reasonable chance of being not only continent, but also potent.

Having a prostate removed by keyhole surgery has some great advantages. The first of these is that the surgeon obtains such a good view of the blood vessels that the patient loses only a small amount of blood. Eden hasn’t had to transfuse a patient after a keyhole prostatectomy for five years, whereas seven out of ten men having the standard radical need a transfusion — in some of these cases the bleeding can be profuse.

The importance of the reduction in bleeding is twofold — the patient will be in much better shape after the operation because the blood loss is less. Second, during the operation the pelvic cavity is apt to fill with blood so that the surgeon is unable to gain a good view of the operating site and further damage may be done.