title: Safety study of umbilical single-port laparoscopic radical prostatectomy with a new DuoRotate system.
abstract: BACKGROUND
  Laparoendoscopic single-site (LESS) radical prostatectomy (RP) has been performed through different approaches. A new DuoRotate manual system developed by Richard Wolf (KeyPort; Richard Wolf GmbH, Knittlingen, Germany) can be applied to RP.
  
  
  OBJECTIVE
  Our aim was to describe the surgical technique and report early outcomes of KeyPort LESS-RP to determine if this procedure is feasible and safe.
  
  
  METHODS
  Prospective study performed between October 2011 and January 2012 to standardize LESS-RP. A total of 31 procedures were performed (10 with and 21 without neurovascular preservation, 8 with and 23 without pelvic lymph node dissection).
  
  
  METHODS
  LESS-RP was performed using the methods outlined in the manuscript. All patients underwent LESS RP by the same surgical team. Access was achieved via a tri-channel reusable KeyPort and one 3.5-mm extra port to facilitate urethrovesical anastomosis and drainage extraction.
  
  
  METHODS
  Preoperative, perioperative, and pathologic outcomes data are presented.
  
  
  CONCLUSIONS
  The mean age of the patients was 64 yr; mean body mass index: 30.7 kg/m(2); mean prostate-specific antigen level: 7 ng/ml; mean operative time: 207 min; and mean estimated blood loss: 258 ml. The average length of stay was 2.9 d and visual analog pain score (range: 0 [no pain] to 10) at day 2 was 1.2. Five focal positive margins (16.7%) were encountered (4.4% for pT2 and 57.1% for pT3). Five cases (16.7%) were pT2a, 3 (10%) were pT2b, 15 (50%) were pT2c, and 7 (23.3%) were pT3a. Lymph node dissection results were negative in all patients. Major complications occurred in two patients (6.5%) (hypercapnia with respiratory acidosis and rectourethral fistula) and minor complications in four (12.9%) (atrial fibrillation, orchitis, transfusion, and vomiting). No case required additional analgesia. Incision was totally hidden in the umbilicus. Study limitations included short follow-up (mean: 20.2 ± 4.1 wk), premature functional data, and absence of a comparative cohort.
  
  
  CONCLUSIONS
  The KeyPort system allows performance of umbilical RP with few complications, a low positive-margin rate, excellent aesthetic results, and very low postoperative pain levels.
authors.affiliation: Hospital Universitario de Getafe, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Cáceres
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Cabrera
authors.forename: Ana
authors.initials: A
authors.lastname: García-Tello
authors.forename: José M
authors.initials: JM
authors.lastname: García-Mediero
authors.forename: Javier C
authors.initials: JC
authors.lastname: Angulo
mesh_terms: D000368:Aged; D004867:Equipment Design; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D014472:Umbilicus