title: A transition to laparoendoscopic single-site surgery (LESS) radical prostatectomy: human cadaver experimental and initial clinical experience.
abstract: OBJECTIVE
  Laparoendoscopic single-site surgery (LESS) represents a novel approach to abdominal surgery. Several applications have already been described. Drawbacks include limited range of motion and need for articulated instruments. Robotic technology could overcome such technical difficulties. We report our experience with LESS radical prostatectomy (LESS-RP) in a cadaver and LESS robot-assisted radical prostatectomy (LESS-RARP) in a human patient.
  
  
  METHODS
  Standard laparoscopic instruments (SLI) and articulated laparoscopic instruments were used in the cadaveric LESS-RP. The da Vinci system was used in the LESS-RARP. Both procedures reproduced standard extraperitoneal laparoscopic prostatectomy as performed at Institut Montsouris. Control of the dorsal venous complex (DVC) and urethrovesical anastomosis (UVA) were key elements evaluated for feasibility.
  
  
  RESULTS
  Cadaveric model: Total operative time (TOT) was 160 minutes, with 5 minutes for the DVC (one stitch) and 35 minutes for the UVA (six stitches). Although articulated instruments were helpful in the operation, SLI remained essential for the procedure. Clinical experience: LESS-RARP was performed for T(1c) prostate cancer. TOT was 150 minutes, including 5 minutes for the DVC (one figure-of-eight stitch) and 30 minutes for the UVA (six interrupted stitches). Blood loss was 500 mL. Bilateral neurovascular preservation was performed, and results of final pathologic examination showed negative surgical margins.
  
  
  CONCLUSIONS
  The human cadaver is an adequate model for LESS-RP, and LESS-RARP is feasible to be performed in the clinical arena. The synergy of robotic technology and LESS represents a new generation of surgery.
authors.affiliation: Ecole Europeen de Chirurgie and Department of Urology, Institut Montsouris/Université Paris Descartes, Paris, France. eric.barret@imm.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.forename: Ali
authors.initials: A
authors.lastname: Kasraeian
authors.forename: Nicolas
authors.initials: N
authors.lastname: Benoist
authors.forename: Anjali
authors.initials: A
authors.lastname: Ganatra
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Francois
authors.initials: F
authors.lastname: Rozet
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D000368:Aged; D002102:Cadaver; D004322:Drainage; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics; D013525:Surgical Instruments