Single-port laparoscopic radical prostatectomy.
OBJECTIVE
To present the initial experience in laparoscopic radical prostatectomy performed exclusively through an umbilical incision using a single three-channel port and specially designed flexible laparoscopic instrumentation.


METHODS
Since November 26, 2007, we have performed single-port laparoscopic radical prostatectomy in 4 patients diagnosed with prostate cancer. Patients with early-stage prostate cancer (T1c), no previous pelvic surgery, and a body mass index <or=35 kg/m(2) were selected for single-port laparoscopic radical prostatectomy. A multichannel port was inserted transperitoneally through a 1.8-cm umbilical incision. No additional extraumbilical instruments or ports were inserted. Urethrovesical anastomosis was performed using free-hand interrupted suturing and extracorporeal knot tying. Data were collected prospectively into our institutional review board-approved data registry.


RESULTS
All cases were completed successfully, without conversion to a standard laparoscopic approach. The total operative time was 285 +/- 30 minutes, with a mean operative time for prostate excision and urethrovesical anastomosis of 3.25 hours and 1.1 hours, respectively. The mean blood loss was 288 +/- 131 mL, and no patient required a blood transfusion. The hospital stay was 2.5 +/- 0.6 days. The Foley catheter was removed 2 weeks (range 1-3) after surgery. No intraoperative complications occurred; however, 1 patient developed a rectourethral fistula that was noted 2 months after surgery. At 18 weeks of follow-up, 3 patients used 1 or 0 pads for continence daily, 2 patients had positive margins noted at the site of extracapsular extension, and all patients had an undetectable prostate-specific antigen level.


CONCLUSIONS
Single-port laparoscopic radical prostatectomy is feasible. Additional investigation is needed to evaluate the safety and oncologic adequacy of this new approach.
Kaouk
Jihad H
JH
Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. kaoukj@ccf.org
Goel
Raj K
RK
Haber
George-Pascal
GP
Crouzet
Sebastien
S
Desai
Mihir M
MM
Gill
Inderbir S
IS
D000368:Aged; D000714:Anastomosis, Surgical; D002404:Catheterization; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011468:Prostatectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods