Login to Access Video or Poster Abstract: MP97-15
Sources of Funding: none

Introduction

Conventional laparoendoscopic radical prostatectomy (LRP) is widely accepted as a standard procedure to treat localized prostate cancer (PCa). Recently, the use of transumbilical laparoendoscopic single-site radical prostatectomy ( LESS-RP) has grown, as it is less invasive for patients, and we have adopted this procedure for prostatectomy cases. The advantages of LESS-RP, such as lower postoperative pain and its cosmetic excellence, have been pointed out. However, LESS-RP is recognized to be a technically challenging procedure even for experts, especially in suturing and dissection. To overcome these challenges, we introduce transurethral-assisted transumbilical laparoendoscopic single-site radical prostatectomy (TU-LESS-RP) . With the technology, many operational equipments can be used through natural orifice to lower the operation difficulty and shorten the operation time. This study is to evaluate the feasibility and advantages of transurethral-assisted technology in LESS-RP for PCa patients. _x000D_

Methods

From Jan. 2014 to Dec.2015, 118 patients underwent RP in our center, including 11 patients were performed by LESS-RP (a single-port with four channels was inserted into the 2.5 cm periumbilical incision), and 107 were performed by TU-LESS-RP (home-made transurethral port were used, Suction and dissociation devices were inserted into transurethral port to assist the surgical operator). All data referring to patient demographics, pathology, and perioperative outcomes were recorded and analyzed.

Results

All the operations were successfully accomplished. No conversion into conventional laparoscopic or open surgery was performed. Compared with LESS-RP, TU-LESS-RP is easier to identify the neck of bladder, avoid the injury of rectum, make anastomosis quickly, expose the anatomic structures clearly , and so on. Consequently, with this technology we make the LESS-RP easy to master and shorten the operation and anastomosis time significantly. Meanwhile, we got satisfied cosmetic and continent results for patients. According to our data, TU-LESS-RP has more significant advantage than LESS-RP in following aspects: the mean operating time (135 min vs 215 min), the median estimated blood loss (108 ml vs 466 ml) , the length of stay (9 d vs 16.5 d), and indwelling catheter time (7.5 d vs 14.5 d). All these patients had satisfied continent and cosmetic effects. For patients experienced lymph nodes dissection, the operating time was 36 min, the average lymph nodes was 10.6, and two patients with positive results (3/9 and 2/12).

Conclusions

LESS-RP is technically challenging although with advantage of less invasive and more cosmetic effects even for experts. To solve these problems, TU-LESS-RP has been developed in our institution, and it has been proved more feasible and safer for localized PCa patients. The technology could minimize the interference between the laparoscopic equipments, shorten the operating time, decrease the risk and complications. TU-LESS-RP for localized PCa patients has just begun, and the number of cases experienced is still small. Being cosmetically highly favorable, this procedure will likely be further developed as a less invasive surgery in the future.

Funding

none