Laparoendoscopic Single-Site Plus One Robot-Assisted Extraperitoneoscopic Radical Prostatectomy for Prostate Cancer

Abstract

Purpose:

Pure laparoendoscopic single-site (LESS) radical prostatectomy is still a challenging procedure even in the robotic era. Herein, we present LESS plus one robot-assisted extraperitoneoscopic radical prostatectomy for prostate cancer.

Materials and Methods:

Three consecutive patients with prostate cancer had radical prostatectomy performed using this technique. The clinical stages are cT1cN0M0 in two and cT3aN0M0 in one patient. The patients were placed on low lithotomy without or with mild Trendelenburg position, which can avoid the complications caused by steep Trendelenburg position. The single-site port was placed on subumbilical 2.5 cm incision and the additional port was located on the cross of right anterior axillary line and umbilical level. We created the extraperitoneal space from posterior rectus sheath using balloon dissector. Three kinds of single-site platforms were used, including da Vinci single-site port, GelPOINT mini advanced access platform (Applied Medical), and homemade glove single port. Each one has its benefits and limitations. We performed radical prostatectomy using the anterior approach technique with da Vinci single-site instruments.

Results:

The operative time ranged from 320 to 400 minutes. No oral intake was limited after operation because of the extraperitoneal approach. Hospital stay was from 5 to 7 days. Blood loss was from 200 to 300 mL. All surgical margins are free of tumor cell. All patients are continent of urination in 3 months evaluation.

Conclusions:

Robot-assisted laparoendoscopic single-site surgery radical prostatectomy is still a challenging procedure. R-LESS plus one technique can be an alternative for a complicated procedure, for example, radical prostatectomy. This technique can reduce the port sites from six in a conventional technique to two with better cosmetic and postoperative pain control benefits. The major limitation of the extraperitoneal approach is lack of space for extended lymph node dissection. The use of da Vinci single-site instruments can keep the triangulation well during operation. Continuous refinement of instruments and technology is essential to allow it to become a routine practice.

No competing financial interests exist.

Runtime of video: 6 mins 53 secs