Extraperitoneal transumbilical laparoendoscopic single-site radical prostatectomy using a homemade single-port device: 20 cases with midterm outcomes

Abstract

To describe the surgical technique and to report the midterm outcomes of laparoendoscopic single-site radical prostatectomy (LESS-RP) with a homemade single-port device. Between August 2009 and October 2011, 20 LESS-RP procedures were performed in a single center by a high-volume surgeon. The surgical methods are outlined in the paper. Preoperative, perioperative, pathologic, midterm oncological, and functional outcomes data were analyzed. On average, patients were 66.1 years old, had a mean body mass index of 24.4 kg/m(2), and a mean prostate-specific antigen (PSA) value of 12.2 ng/ml. No conversion was required; however, a single additional 5-mm port was required in one case. The mean operative time was 248 min; mean estimated blood loss was 94 ml. The mean visual analog pain score at day 3 was 1.5 out of 10, and the mean hospital stay was 15.4 day. Pathology showed one focal positive margin (5 %) in a T3a patient, and mean Gleason score was 6.7. There were a total of four Clavien grade 2 complications. The median follow-up was 22.8 month (range 12-36 month). No PSA recurrence was detected during follow-up period; the potency rate after bilateral neurovascular bundle preservation was 60 % (3/5). Complete continence recovery (no pad) was observed in 85 % of the patients at 1 year, in 90 % at 2 years, and in all three patients at 3 years. LESS-RP is technically feasible and safe, with excellent cosmesis, low postoperative pain levels, and acceptable midterm oncological, and functional outcomes. Comparative investigation to conventional LRP is needed.