Laparoendoscopic Single-site Radical Prostatectomy Research Articles

Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

ObjectiveThis prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system (Beijing Surgerii Technology Co., Ltd., Beijing, China), a novel purpose-built robotic system, in single-port robotic radical prostatectomy. MethodsSixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system. The demographic and baseline data, surgical, oncological, and functional outcomes as well as follow-up data were recorded. ResultsThe mean operative time was 226.3 (standard deviation [SD] 52.0) min, and the mean console time was 183.4 (SD 48.3) min, with the mean estimated blood loss of 116.3 (SD 90.0) mL. The mean length of postoperative hospital stay was 4.50 (SD 0.97) days. Two patients had postoperative complications (Clavien-Dindo Grade II), and both patients improved after conservative treatment. All patients’ postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge. The mean prostate-specific antigen level further decreased to a mean of 0.0219 (SD 0.0641) ng/mL 6 months after surgery. Thirty days postoperatively, 12 out of 16 patients reported using no more than one urinary pad per day, and all patients reported satisfactory urinary control without the need for pads 6 months after surgery. ConclusionThe SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches. Tumor control and urinary continence were satisfying for patients enrolled in. The next phase involves conducting a large-scale, multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

R-LESS-RP versus C-LESS-RP: a single-institution retrospective comparative study

This study aimed to compare the peri- and postoperative outcomes of patients treated with conventional versus robot-assisted laparoendoscopic single-site radical prostatectomy (C-LESS-RP vs. R-LESS-RP). Data of patients with prostate cancer (106 who underwent C-LESS-RP, 124 underwent R-LESS-RP) were retrospectively collected and analyzed. All operations were performed by the same surgeon from January 8, 2018, to January 6, 2021, in the same institution. Information on clinical characteristics and perioperative outcomes was obtained from records at the medical institution. Postoperative outcomes were acquired from follow-up. Intergroup differences were retrospectively analyzed and compared. All patients had similar clinical characteristics in meaningful aspects. The perioperative outcomes were better with R-LESS-RP than with C-LESS-RP in terms of operation time (120 min vs. 150 min, p < 0.05), estimated blood loss (17.68 ml vs. 33.68 ml, p < 0.05), and analgesic duration (0 days vs. 1 days, p < 0.05). The drainage tube duration and postoperative stay did not differ significantly between groups. However, R-LESS-RP was more expensive than C-LESS-RP (56559.510 CNY vs. 44818.27 CNY, p < 0.05). The patients who underwent R-LESS-RP had better urinary incontinence recovery and higher European quality of life visual analog scale scores than those who underwent C-LESS-RP. However, no significant intergroup difference was noted in biochemical recurrence. In conclusion, R-LESS-RP could achieve better perioperative outcomes, especially for those skilled surgeons who have mastered C-LESS-RP. Additionally, R-LESS-RP accelerated the recovery from urinary incontinence effectively and presented some benefits in health-related quality of life with additional costs.

Needle-Assisted Laparoendoscopic Single-Site Radical Prostatectomy Using a New Series of Steerable Instruments: Feasible Option to Overcome Current Limits?

Abstract Introduction: Laparoendoscopic single-site surgery (LESS) made its introduction in the urologic community in 2007 and has significantly evolved since then.1–3 However, such a procedure remains a technical challenge.4 In this study, we have evaluated the feasibility of a needle-assisted LESS-radical prostatectomy (RP) procedure using a recently developed series of steerable laparoscopic instruments (Steerable Instruments, Ghent, Belgium) each having seven degrees of freedom.5 In contrast with existing articulated instruments, the steerable instruments permit torque transmission, in which rotation of the surgeon's wrist results in a rotation of the tip, even in bent position. Materials and Methods: The study was carried out in a nonsurvival porcine model, approved by the Ghent University ethical committee (EC2016/83). The procedure was designed and trained before on a series (more than six) of cadavers. A 12-mm Airseal® trocar enabling access for the steerable instruments and a 10-mm trocar for a 3...

P201 - Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with davinci single-site® platform. Concept and evolution of the technique following an ideal phase 1

P201 - Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with davinci single-site® platform. Concept and evolution of the technique following an ideal phase 1

Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with daVinci Single-Site® platform. Concept and evolution of the technique following an IDEAL phase 1

To describe the evolution of robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) performed with the daVinci Single-Site Platform® and a home-made multiport aimed to overcome classical drawbacks of LESS, still present with this platform. Between 09/2015 and 06/2017 12 patients underwent R-LESS RP for clinical localized prostate cancer. Following a "phase 1 (development-stage)" innovation, development, exploration, assessment, long-term study (IDEAL) framework, different solutions were drawn to overcome drawbacks of daVinci Single-Site Platform®, included 3 (A, B, and C) multi-ports developed and evaluated in term of advantages/drawbacks concerning ergonomy. The end points of this study were: feasibility, safety, efficacy, by reporting rational description of multiports configuration, demographics, perioperative variables, functional and oncological results. Semi-flexible robotic 5-mm needle-holder instead of Maryland forceps, 30° lenses up and barbed-suture allowed overcoming limits of robotic-platform. Multiport-C (GelPOINT Advanced-Access® and an extra 8-mm robotic trocar outside the multiport) showed the best compromise to ensure both surgeon and bed-side assistant to reproduce a standard robotic procedure. No conversion to either standard robotic or open technique or intraoperative complications occur in any case. Two patients experienced "high-grade" Clavien-Dindo complications. After 12.4 months follow-up, all patients were continent without any sign of biochemical relapse and among 5 preoperative potent patients submitted to nerve-sparing dissection, 4 reported good erectile-function. R-LESS-RP is feasible and safe in the hands of experienced minimally-invasive surgeons. Do date, we recommend a hybrid solution with a home-made multiport and use of an additional standard robotic trocar which allows the use endowrist® technology instruments.

First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform

This study aimed at reporting our first experience with robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with single-site VesPa platform (Intuitive Surgical Inc.).A 68-year-old-man presenting with a cT1c adenocarcinoma Gleason Score 3+4=7 in 4/12 bilateral cores underwent a transperitoneal robotic LESS-RP with a single-site Vespa platform. Initial PSA, prostate weight, and body mass index (BMI) were 4.4ng/ml, 45g, and 25, respectively. Instruments and camera cross within the Single-Site port; the da Vinci System software detects and reassigns the user's hands with the instruments position. The single-site port is inserted through a 2-cm intraumbilical incision. The robotic 8.5mm scope and two surgical curved instruments (fenestrated bipolar forceps and cautery hook) are introduced through the ports and used for most of the procedure, whereas a wristed needle driver on the right hand is used for the reconstructive steps. An additional 12mm port (Air Seal, SurgiQuest) is placed in a midline between the umbilicus and the right iliac spine in order to facilitate table assistance during surgery and to place a drain at the end of the procedure.Operative time and blood loss were 300min and 400mL, respectively. The postoperative course was uneventful. The drain and the catheter were removed on days 1 and 6, respectively. The patient experienced a temporary mild stress incontinence (one pad at sixth month) and erectile dysfunction.Our first robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with the single-site VesPa platform was associated with acceptable operative times and perioperative outcome. This procedure is feasible without complications, provided that a proper patient selection has occurred. Limited movements together with the lack of the fourth robotic arm require a considerable expertise in robotic surgery. Some tricks can help overcome technical limitations. The Robotic LESS-RP reduces in some measure the limitations of conventional LESS RP, although further refinement of the robotic instruments is necessary.

MP97-15 NEW APPROACH: FROM LAPAROENDOSCOPIC SINGLE-SITE RADICAL PROSTATECTOMY (LESS-RP) TO TRANSURETHRAL-ASSISTED LESS-RP (TU-LESS-RP)

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VIII1 Apr 2017MP97-15 NEW APPROACH: FROM LAPAROENDOSCOPIC SINGLE-SITE RADICAL PROSTATECTOMY (LESS-RP) TO TRANSURETHRAL-ASSISTED LESS-RP (TU-LESS-RP) Qingyi Zhu, Yunfei Wei, Jian Su, Lin Yuan, Yang Zhang, Qingling Zhang, Chen Zhu, Luming Shen, Zijie Lu, Zijie Lu, and Zijie Lu Qingyi ZhuQingyi Zhu More articles by this author , Yunfei WeiYunfei Wei More articles by this author , Jian SuJian Su More articles by this author , Lin YuanLin Yuan More articles by this author , Yang ZhangYang Zhang More articles by this author , Qingling ZhangQingling Zhang More articles by this author , Chen ZhuChen Zhu More articles by this author , Luming ShenLuming Shen More articles by this author , Zijie LuZijie Lu More articles by this author , Zijie LuZijie Lu More articles by this author , and Zijie LuZijie Lu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3059AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. 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. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1308-e1309 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Qingyi Zhu More articles by this author Yunfei Wei More articles by this author Jian Su More articles by this author Lin Yuan More articles by this author Yang Zhang More articles by this author Qingling Zhang More articles by this author Chen Zhu More articles by this author Luming Shen More articles by this author Zijie Lu More articles by this author Zijie Lu More articles by this author Zijie Lu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transurethral assistant transumbilical laparoendoscopic single-site radical prostatectomy.

The laparoendoscopic single-site (LESS) technique is the latest technical innovation in laparoscopic surgery to undergo exponential development in urology. This study undertaken to illustrate our initial experience LESS radical prostatectomy (RP) and analyze early outcomes. Nineteen patients diagnosed with prostate cancer underwent LESS-RP in our institute. The patients were divided into two groups: conventional LESS and transurethral assistant LESS. Preoperative, perioperative, postoperative, pathologic, and functional outcomes data were assessed. With the help of a transurethral assistant, the mean operation and anastomosis time were decreased markedly. No focal positive margins were encountered. No prostate-specific antigen recurrence was detected 1 month postoperatively. Complete continence recovery (no pad) was observed in 32% of the patients at 1 month after the operation. No intraoperative and postoperative complications were reported. LESS-RP is a feasible and effective surgical procedure for treatment of prostate cancer. Moreover, transurethral assistant LESS could reduce the difficulty of LESS-RP and shorten the operation time.

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

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.

Transvesical approach laparoendoscopic single-site radical prostatectomy: for organ-confined prostate cancer: report of 8 cases

Objective To investigate the feasibility of applying transvescal approach laparoendoscopic single-site radical prostatectomy (TVSSLRP) and assess the oncological and functional outcomes.Methods Eight patients with clinically localized prostate cancer (PCa) of low risk underwent TVSSLRP.Demographic data were accrued including patient age,body mass index (BMI),preoperative PSA level,the International Index of Erectile Function 5,biopsy Gleason score,clinical TNM stage and D'Amico risk classification.One surgeon performed all TVSSLRP procedures.A homemade triple-port was introduced percutaneouly into the bladder to establish pneumovesicum through a 4 cm incision.The major steps of the surgery were described as follows:initial incision was made along posterior margin of the bladder neck to expose bilateral vas deference and spermatic vesicle.After opening Denonvilliers' fascia and extending the space to lateral prostatic pedicles,an intra-fascial nerve sparing procedure was performed.The puboprastatic ligaments were then separated close to the prostate surface and the dorsal vein complex was cautiously swept off.Subsequently,careful apical dissection and urethral transection was sequentially conducted. To reduce the tension of vesico-urethral anastomosis,3 additional incisions parallel to vesio-urethral margin were created and a novel tension - reduced V-LocTM barbed polydioxanone sutures was used. Results All the operations were successfully performed and there was no conversion to standard laparoscopic approach or open surgery.The total operative time range was 75 - 180 min with mean time of 125 min.The blood loss was 85 -450 ml with mean 140 ml and no blood transfusion was required.The catheter was removed after a mean (range) of 14 (9 -16) days.No intra-operative complications occurred. No patient had positive surgical margins.The mean (range) hospital stay was 17 (13 -25) days after surgery. All the cases were continent after removal of the catheter.No cases demonstrated vesico-urethral stricture and biochemical recurrence on 12 - 18 months follow up postoperatively. Conclusions TVSSLRP is technically feasible for cases with organ-confined prostate cancer with good oncological and functional results. Key words: Laparoscope; Prostate cancer; Radical prostatectomy; Transvesical; Laparoendoscopic single-site

Laparoendoscopic single-site radical prostatectomy

Objective To verify the safety and feasibility of applying laparoendoscopic singlesite radical prostatectomy (LESS-LRP) in the treatment of prostate cancer. Methods From Sept. to Dec. 2010, LESS-LRP was used to treat 2 early stage prostate cancer patients. The LESS-LRP was preformed through extra-peritoneal approach by using standard laparoscopic instruments and a 5 mm flexible laparoscope. This technique were evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay, pathological results and post-operative PSA levels. Results All procedures of the 2cases were completed with LESS-LRP without conversion to standard laparoscopic or open radical prostatectomy. The operative times for LESS-LRP were 280 and 285 min, estimated blood loss were 400 and 200 ml, respectively. There was no severe intraoperative complication. The drainage times were 2 and 6 d, the VAPS in the first post-operative day were 1 and 0, and post-operative hospital stay were 14 and 7 d. There was no secondary bleeding or wound infection. The 2 prostate cancer cases were all in pathological stage pT2c N0 M0. Surgical margins of the specimens were negative. The first case showed PSA of 0. 033 ng/ml 1 month after the surgery. Conclusion LESS-LRP can be an exploratory option in clinical for the treatment of prostate cancer. Key words: Laparoendoscopic single site surgery; Prostatic neoplasmas; Carcinoma; Radical prostatectomy

Laparo-endoscopic single-site radical prostatectomy: Feasibility and technique

BackgroundAs laparoscopy becomes a standard approach in many urological procedures, researchers strive to make minimally invasive surgery less invasive. Our objective was to apply recent innovations in equipment and surgical approaches to develop the technique and perform laparo-endoscopic single site radical prostatectomy (LESS-RP). MethodsThe technique for LESS-RP was derived by combining existing techniques of standard laparoscopic RP and developing techniques of urological LESS. This incorporated newly available low-profile trocars, flexible instruments and a flexible-tip laparoscope. The procedure was performed through a single 3-cm transverse infra-umbilical incision. LESS-RP was completed successfully via a single operative site without auxiliary needles or trocars. Perioperative variables and postoperative outcomes were recorded and measured. ResultsThe operative time was 424min and the hospital stay was 10days because of a vesicourethral leak and ileus. The anastomotic leak resolved and the urethral catheter was removed at 4weeks after surgery. The final pathology showed negative margins and Gleason 3+4 pT2c prostatic adenocarcinoma. ConclusionsLESS-RP is feasible by replicating laparoscopic RP techniques and incorporating the LESS technique with the advent of flexible-tip laparoscopes and flexible instruments. After a learning curve has been overcome, this should be further tested prospectively to compare oncological and functional outcomes with laparoscopic and robotic-assisted RP.

Extraperitoneal laparo-endoscopic single-site radical prostatectomy: first experience

Up to now, laparo-endoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. The objective of the study is to report the first clinical experience with a LESS endoscopic extraperitoneal radical prostatectomy. A 74-year-old man presented with a clinically localized prostate cancer (PSA 9.9, Gleason score 3 + 3 = 6). Consent was obtained for LESS radical prostatectomy. After a 2-cm midline subumbilical incision, the preperitoneal space was created using a balloon trocar. Then, the Triport™ was introduced. Using straight, as well as pre-curved instruments, the radical prostatectomy was performed in accordance with the well-described technique of endoscopic extraperitoneal radical prostatectomy. The procedure was completed successfully. Overall operation time was 290 min. The estimated blood loss was 100 mL. There were no intra-or postoperative complications. No additional ports were required. On the 6th postoperative day, a cystogram was performed. No leak was demonstrated, enabling catheter removal. Histopathology revealed bilateral adenocarcinoma with no extracapsular extension and a Gleason sum of 3 + 4 = 7. Surgical margins were negative. Two weeks postoperatively, the patient reported the use of only one safety pad for continence. An extraperitoneal laparo-endoscopic single-site radical prostatectomy is technically challenging but can be accomplished. A multi-instrument port and purpose-built equipment are mandatory. The oncologic outcome was not compromised. Additional short- and long-term studies are necessary to clarify the role of LESS in radical prostatectomy regarding the oncologic and functional outcome as well as the potential benefits like reduced tissue trauma and pain.