Is there really LESS in the future for prostate cancer?

LESS stands for laparo-endoscopic single-site surgery. To all intents and purposes it is laparoscopic surgery through one small abdominal incision (a “port”) as opposed to the five or six that are currently used.

At the annual meeting of the American Urological Association (AUA), Autorino et al. provided an update on experience with this investigational procedure as carried out at The Cleveland Clinic. The argument in favor of LESS is that it may (there’s that word again) offer a further decrease in morbidity compared to current “multi-port laparoscopy” (whether carried out with the help of a robot or not).

LESS has already been performed regularly and successfully for procedures like nephrectomy (the surgical removal of the kidney). However, it’s use as a method to treat prostate cancer and other prostate disorders is relatively minimal to date. What is of interest is that the research team at The Cleveland Clinic have been using this technique to perform not just surgical removal of specific organs, but also cryotherapy. In theory, it may be possible over time to use LESS to perform radical prostatectomy, complete prostate cryotherapy, focal cryotherapy, focal laser surgery and other methods for the treatment of prostate cancer. The question will be whether the skills needed to carry out these procedures with a high probability of good, reproducible outcomes are sufficiently easy to learn and whether there is any cost benefit.

It is worth noting that manufacturers of robotic equipment would certainly consider LESS to be a whole new opportunity to market revised robotic systems to all the hopsitals that bought the first and second generations of equipment. However, before we go down that path it would seem like a good idea to make sure that young surgeons graduating from medical schools in the near future are actually capable of carrying out LESS with the same level of skill and expertise as experienced surgeons today bring to the conduct of a high quality radical prostatectomy.

The researchers at The Cleveland Clinic appear to be highly cognizant of this need. They claim only that their data and experience demonstrate “acceptable peri- and early post-operative outcomes of LESS and establishes LESS to be feasible for a broad range of urologic procedures.” They acknowledge that long-term data and comparative studies with conventional laparoscopic procedures will be needed in the future.

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