Laparoendoscopic single-site radical prostatectomy: technique and initial outcomes

Background Laparoendoscopic single-site surgery radical prostatectomy (LESS-RP) is a challenging urological procedure and needs to be further evaluated. This study was undertaken to illustrate the safety and initial results of pure LESS-RP with conventional available instruments. Methods A prospective clinical database was established in September 2010 to assess the outcome following the introduction of LESS-RP at our institution. By June 2012, six procedures had been performed. The mean patient age was 74.7 (74.0-76.0) years. The mean body mass index (BMI) was 23.8 (19.5-32.2) kg/m(2). The LESS-RP was preformed through an extra-peritoneal approach using single port access with QudaPort, 0 degrees lens 5 mm flexible tip video-laparoscope and available conventional laparoscopic instruments. Parameters assessed were operative time, estimated blood loss, intra-operative complications, drainage time, postoperative pain score (visual analogue pain scale (VAPS), 0-10), pathological results, and postoperative prostate specific antigen (PSA) levels. Results LESS-RP was completed for all six cases without additional trocar placement or conversion to standard laparoscopic or open radical prostatectomy. The mean operative times were 252.5 (190.0-305.0) minutes, estimated blood loss was 300 (100-500 ml). There was no documentable intraoperative complication. The mean wound-drainage time was 5.2 (2.0-7.0) days, and the first postoperative day VAPS was 0.8 (0-3.0). Final pathological staging was pT2aN0M0 in four cases and pT2cN0M0 in two cases. Surgical margins were negative for all cases. The one-month post-operative PSA was less than 0.02 ng/ml in each case. All patients were continent without pad usage at 1 year postoperatively. Conclusion The technique of pure LESS-RP is feasible and early outcomes are acceptable. Chin Med J 2012;125(21):3815-3820