V1241: Scar-less Nerve-sparing Radical Prostatectomy

Video

Introduction and Objectives
Nerve-sparing radical prostatectomy has evolved in the last decades to become the gold-standard treatment of low-risk localized prostate cancer. Robotic surgery has reached a very high technological development; however, a low-cost minimally invasive and precise approach needs to be established. LESS surgery through umbilical single port could be an excellent alternative with improved aesthetical and economical results.

Methods
We present a surgical demonstration of incision-less nerve-sparing radical prostatectomy, performed through a single-port placed in the umbilicus with the aid of a 3.5 mm port to facilitate the anastomosis and final drainage placement, in a 63 years-old male patient (Body Mass Index 32) with low-risk localized prostate cancer. An umbilical 2.5 cm incision was used for the introduction of a prototype of the reusable Richard Wolf single-port system that does not need external fixation and incorporates new DouRotate © instruments with great precision of movements.

Results
We have systematized nerve-sparing radical prostatectomy with this new prototype and here present the main steps of this new minimally invasive technique that implies an aesthetical advantage and even prompts the brief recovery of laparoscopic surgery. The procedure lasted for 290 min and bleeding was 540 cc. Drainage was taken out in 24 hours and the patient was discharged on the second day. Small inconspicuous scar was accompanied by notoriously diminished pain and no analgesic need. Incision was not visible at one month follow-up. Surgical margins were negative, postoperative PSA was undetectable and the patient was continent and potent after surgery.

Conclusions
Scar-less nerve-sparing radical prostatectomy through a single-port umbilically placed is a feasible solution to treat localized prostate cancer. This procedure may achieve excellent results in experienced hands and can be considered the most beneficial option both in aesthetical and economical terms.

Funding: None