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. 2011 Mar;9(1):73-7.
doi: 10.1016/j.aju.2011.03.017. Epub 2011 May 6.

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

Amin S Herati  1 , Mohamed A Atalla  1 , Sylvia Montag  1 , Sero Andonian  1 , Louis R Kavoussi  1 , Lee Richstone  1
Affiliations

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

Amin S Herati et al. Arab J Urol. 2011 Mar.

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.

Keywords: LESS, laparo-endoscopic single-site surgery; Laparoscopy; NOTES, natural orifice translumenal endoscopic surgery; RALP, robotic-assisted laparoscopic RP; RP, radical prostatectomy; Radical prostatectomy; Single-port; Single-site; Surgery; VAS, visual analog scale.

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Figures

Figure 1
Figure 1
Flexible shears used for prostatic apical dissection and urethral transection.
Figure 2
Figure 2
Flexible needle drivers make intracorporeal suturing and tying feasible during LESS.
Figure 3
Figure 3
Schematic representation of trocar placement.
See this image and copyright information in PMC

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