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Laparo-endoscopic single-site radical prostatectomy: Feasibility and technique ☆

View Article: PubMed Central

ABSTRACT

Background: As laparoscopy becomes a standard approach in many urological procedures, researchers strive to make minimally invasive surgery less invasive. Our objective was to apply recent innovations in equipment and surgical approaches to develop the technique and perform laparo-endoscopic single site radical prostatectomy (LESS-RP).

Methods: The technique for LESS-RP was derived by combining existing techniques of standard laparoscopic RP and developing techniques of urological LESS. This incorporated newly available low-profile trocars, flexible instruments and a flexible-tip laparoscope. The procedure was performed through a single 3-cm transverse infra-umbilical incision. LESS-RP was completed successfully via a single operative site without auxiliary needles or trocars. Perioperative variables and postoperative outcomes were recorded and measured.

Results: The operative time was 424 min and the hospital stay was 10 days because of a vesicourethral leak and ileus. The anastomotic leak resolved and the urethral catheter was removed at 4 weeks after surgery. The final pathology showed negative margins and Gleason 3 + 4 pT2c prostatic adenocarcinoma.

Conclusions: LESS-RP is feasible by replicating laparoscopic RP techniques and incorporating the LESS technique with the advent of flexible-tip laparoscopes and flexible instruments. After a learning curve has been overcome, this should be further tested prospectively to compare oncological and functional outcomes with laparoscopic and robotic-assisted RP.

No MeSH data available.


Schematic representation of trocar placement.
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f0015: Schematic representation of trocar placement.

Mentions: After resolution of the anastomotic leak based on cystography, the urethral catheter and extravesical drain were removed at 4 weeks after LESS-RP. The final pathology was Gleason 3 + 4 pT2c adenocarcinoma with negative margins. At the 3-month follow-up the serum PSA level was undetectable. The incision made at the umbilicus was found to be well healed with no evidence of wound infection or incisional hernia (Fig. 3). The patient reported almost complete continence (no pads, and rare stress incontinence events) and potency sufficient for penetrative sexual relations at 3 months after surgery. At 3 months the patient responded to a Sexual Health in Men questionnaire, with a score of 17. However, he administered prostaglandin intra-urethral suppositories occasionally.


Laparo-endoscopic single-site radical prostatectomy: Feasibility and technique ☆
Schematic representation of trocar placement.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374145&req=5

f0015: Schematic representation of trocar placement.
Mentions: After resolution of the anastomotic leak based on cystography, the urethral catheter and extravesical drain were removed at 4 weeks after LESS-RP. The final pathology was Gleason 3 + 4 pT2c adenocarcinoma with negative margins. At the 3-month follow-up the serum PSA level was undetectable. The incision made at the umbilicus was found to be well healed with no evidence of wound infection or incisional hernia (Fig. 3). The patient reported almost complete continence (no pads, and rare stress incontinence events) and potency sufficient for penetrative sexual relations at 3 months after surgery. At 3 months the patient responded to a Sexual Health in Men questionnaire, with a score of 17. However, he administered prostaglandin intra-urethral suppositories occasionally.

View Article: PubMed Central

ABSTRACT

Background: As laparoscopy becomes a standard approach in many urological procedures, researchers strive to make minimally invasive surgery less invasive. Our objective was to apply recent innovations in equipment and surgical approaches to develop the technique and perform laparo-endoscopic single site radical prostatectomy (LESS-RP).

Methods: The technique for LESS-RP was derived by combining existing techniques of standard laparoscopic RP and developing techniques of urological LESS. This incorporated newly available low-profile trocars, flexible instruments and a flexible-tip laparoscope. The procedure was performed through a single 3-cm transverse infra-umbilical incision. LESS-RP was completed successfully via a single operative site without auxiliary needles or trocars. Perioperative variables and postoperative outcomes were recorded and measured.

Results: The operative time was 424 min and the hospital stay was 10 days because of a vesicourethral leak and ileus. The anastomotic leak resolved and the urethral catheter was removed at 4 weeks after surgery. The final pathology showed negative margins and Gleason 3 + 4 pT2c prostatic adenocarcinoma.

Conclusions: LESS-RP is feasible by replicating laparoscopic RP techniques and incorporating the LESS technique with the advent of flexible-tip laparoscopes and flexible instruments. After a learning curve has been overcome, this should be further tested prospectively to compare oncological and functional outcomes with laparoscopic and robotic-assisted RP.

No MeSH data available.