The transrectal single port laparoscopic radical prostatectomy in a cadaver model.
OBJECTIVE
To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route.


METHODS
After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure.


RESULTS
Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity.


CONCLUSIONS
Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
Department of Urology, Kartal Training and Research Hospital, İstanbul, Turkey.
Oktay
O
Akça
Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA.
Homayoun
H
Zargar
Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA.
Riccardo
R
Autorino
Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA.
Luis Felipe
LF
Brandao
T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey.
Ahmet Selçuk
AS
Gürler
T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey.
Abdullah
A
Avşar
Department of Urology, Medipol University Hospital, İstanbul, Turkey.
Rahim
R
Horuz
Department of Urology, Medipol University Hospital, İstanbul, Turkey.
Selami
S
Albayrak
Laparoscopic; radical prostatectomy; single port; transrectal