Evolution of “single port” laparoscopic prostate surgery


Early in the existence of The “New” Prostate Cancer InfoLink, in an article entitled “A note on NOTES,” Dr. Krongrad reported from an early medical meeting on the potential for “Natural Orifice Translumenal Endoscopic Surgery,” in which all the needed operative equipment is inserted through a natural orifice, such as the vagina or the rectum. Later that year, we also reported on the first known case of a single-port, robot-assisted, laparoscopic radical prostatectomy (RALP), carried out at the Cleveland Clinic, in which all the equipment is inserted through a single small incision (as opposed to the five small incisions customary today).

An article by Desai et al. now provides additional data on the initial experience with laparoendoscopic single-site (LESS) surgery — also known as “single-port” surgery — in 100 urology patients, 32 of whom received a form of prostatectomy known as “transvesical simple prostatectomy.”

All the procedures were carried out between October 2007 and December 2008. The vast majority were for some form of kidney surgery or prostate surgery.

According to the authors, during the study period:

  • LESS procedures accounted for 15 percent of all laparoscopic cases by the authors for similar indications.
  • Conversion to standard multiport laparoscopy was necessary in 3 cases.
  • Addition of a single 5-mm port was necessary in 3 cases.
  • Conversion to open surgery was necessary in 4 cases.
  • One death occurred following simple prostatectomy — in a Jehovah’s Witness who refused blood transfusion following hemorrhage.
  • Intra- and postoperative complications occurred in 5 and 9 cases, respectively.
  • Mean operative time was 113 minutes and hospital stay time was 3 days for the prostatectomies.

The authors conclude that “LESS surgery is technically feasible” for a variety urologic surgery procedures. However, The “New” Prostate Cancer InfoLink has the strong impression that there is a way to go before single-post surgery becomes a “standard operating procedure” (literally) for carrying out radical prostatectomies.

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