'LESS' radical prostatectomy: a pilot feasibility study with a personal original technique

What's known on the subject? and What does the study add? Laparoendoscopic single-site surgery (LESS) provides the ability to perform major surgery with minimal incisions and nearly scar-free results. A pure single port laparoscopic radical prostatectomy has been previously described as a feasible but challenging procedure with a high complications' rate. We describe a modification of the single-port laparoscopic radical prostatectomy, using a periumbilical multichannel port plus a second port placed in the left iliac fossa with the aim of having an adequate working angle during the most critical steps of the procedure. This minimally invasive technique is a safe procedure and appears to be a good compromise between a pure single multichannel port and a standard multitrocar laparoscopic approach. OBJECTIVE We evaluated the feasibility and the potential advantages of a modification of the single-port laparoscopic radical prostatectomy using a periumbilical multichannel port plus a second port placed in the left fossa with the aim of having an adequate working angle during the most critical steps of the procedure. PATIENTS AND METHODS Between March and September 2009 we operated on five patients with early-stage prostate cancer (T1c) and a normal body mass index (< 25). The procedure was carried out with a specially-designed multichannel trocar which contains two 5 mm and one 10 mm ports plus a 5 mm port placed in the left iliac fossa in order to have an adequate working angle. The first two patients received a nerve sparing radical prostatectomy. RESULTS All cases were completed successfully in a mean operative time of 225 minutes (range 210-250) with blood losses of less than 100 ml. All patients were discharged from the hospital in 3rd postoperative day and the catheter was always removed seven days from surgery. No intraoperative complications occurred. The pathological tumour stage revealed pT2bNo prostate cancer in all five cases without positive surgical margins. After a mean follow-up of 4 months (range 1-7) all patients have an undetectable prostate-specific antigen level and no postoperative early major complications. The first two patients were fully continent respectively after 3 and 8 weeks after surgery, the third patient uses one safety pad after three month from surgery. The last two patients have a moderate incontinence and are currently under rehabilitation. Regarding potency the first patient had intercourses without any therapies after two months from surgery while the second one (6 months follow up) has partial penile tumescence using oral vardenafil. CONCLUSION Two ports laparoscopic radical prostatectomy is feasible in very selected cases. However, our pilot study should be still considered a technical report and the limits of the technique must still be defined in a larger population and by other investigators.