V11-14: Laparo-endoscopic single site (LESS) plus one port (POP) radical prostatectomy
VideoIntroductions and Objectives
Radical prostatectomy is the gold standard treatment for prostate cancer. In recent years, technological advances have permitted to decrease the number of ports used in laparoscopic surgeries down to a single port. Still, there is a technical difficulty performing these surgeries due to lack of triangulation of the instruments and their clashing outside and within the patient’s body. Herein, we present a video that demonstrates the surgical technique of LESS POP radical prostatectomy.
From February to August 2014, 19 consecutive patients underwent radical prostatectomy by this technique. We describe the surgical technique as well as tips and tricks for this procedure.
Patients’ age ranged between 55-75 years (mean-63.3). The surgery duration was between 165-300 minutes (mean-240). One patient underwent concomitant umbilical hernia repair. The average hospital stay was 3 days (range 2-7). In 15 patients (79%), the catheter was removed after 7 days. In 4 other patients, the catheter was left indwelling longer- in 3 due to urine leak and in 1 because of rectal injury and lymphorrhea. Positive margins were identified in 6 patients. There were no conversions to standard laparoscopic or open surgery. In 4 cases an additional 5 mm trocar was used. In 2 -due to difficulty to progress with dissection. In one case due to the need to expedite the surgery in a patient with anesthesia difficulties (patient with severe COPD) and in another it was required for suturing a rectal injury. Pathology: Gleason 6,7,8,9 was in 7,9,1 and 2 cases respectively, stage pT2b, pT3a and pT3b was in 13,3 and 3 respectively. Ten patients underwent lymph node dissection ( mean 15.4 nodes ). In the follow-up period that ranged between 1 to 7 months continence rate is 80%
We described a new and innovative laparoscopic technique for treating prostate cancer. This technique has the advantages of a minimally invasive procedure without oncological rules compromise. It enables the triangulation of the instruments and is ergonomically better and more comfortable for the surgeon.