The vagina may not “be your friend,” but …

A while ago now, in “A note on NOTES,” Dr. Krongrad reported on his learnings from a symposium and workshop on single-port laparoscopic sugical techniques (as opposed to the common multi-port approches used by most urologists to carry out radical prostatectomy today). His article was widely read.

However, while transvaginal, single-port laparoscopic surgery (as referenced by Dr. Krongrad in his earlier article) may not be feasible for the removal of the prostate, Kaouk et al. have now published the first report of a single-port, robot-assisted, laparoscopic radical prostatectomy (RALP), carried out at the Cleveland Clinic. This report actually addresses three surgical procedures carried out in this manner: the aforementioned RALP, a radical nephrectomy (removal of a kidney), and a “dismembered pyeloplasty” (an operation to remove or reconstruct an obstruction in the pelvis of the kidney).

In this report, Kaouk and his colleagues state that in fact two instrument ports were inserted through a single umbilical incision. They go on to state that duration of the procedures for the radical prostatectomy was 5 hours, the estimated blood loss was 250 ml, the length of the hospital stay was 36 hours, and the margins of resection were negative. The conclude that, “Technical challenges of single-port surgery that may limit its widespread acceptance can be addressed by using robotic technology.”

There would seem to be little doubt that the technical feasibility of “single-port” laparoscopic surgery will, in time, make this technique a procedure of choice for radical prostatectomy. The critical question for patients (and their insurance providers) will be whether the level of technical skill of individual surgeons justifies asking for (and paying for) this procedure. We will also have to address the question of how one knows that one’s potential surgeon has the requisite skilll level.

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