European Urology

Abstract

Background

Laparoendoscopic single-site (LESS) surgery is challenging. To help overcome current technical and ergonomic limitations, the da Vinci robotic platform can be applied to LESS.

Objectives

Our aim was to describe the surgical technique and to report the early outcomes of robotic LESS (R-LESS) radical prostatectomy (RP).

Design, setting, and participants

A retrospective review of prospectively captured R-LESS RP data was performed between May 2008 and May 2010. A total of 20 procedures were scheduled (12 with and 8 without pelvic lymph node dissection).

Surgical procedure

R-LESS prostatectomy was performed using the methods outlined in the paper and in the supplemental video material.

Interventions

All patients underwent R-LESS RP by one high-volume surgeon. Single-port access was achieved via a commercially available multichannel port. The da Vinci S and da Vinci Si surgical platform was used with pediatric and standard instruments.

Measurements

Preoperative, perioperative, pathologic, and functional outcomes data were analyzed.

Results and limitations

The mean age was 60.4 yr; body mass index was 25.4 kg/m². The mean operative time was 189.5 min; estimated blood loss was 142.0 ml. The average length of stay was 2.7 d, and the visual analog pain score at discharge was 1.4 of 10. Four focal positive margins were encountered, with two occurring during the first three cases. Pathology revealed a Gleason score of 3 + 3 in 3 patients, 3 + 4 in 11 patients, 4 + 3 in 4 patients, and 4 + 4 in 2 patients. There were a total of four complications according to the Clavien system including one grade 1, two grade 2, and one grade 4. The median follow-up has been 4 mo (range: 1–24 mo). Study limitations include the small sample size, the short follow-up, and the lack of comparative cohort.

Conclusions

The R-LESS RP is technically feasible and reduces some of the difficulties encountered with conventional LESS RP.

Take Home Message

Our preliminary experience with robotic laparoendoscopic single-site (R-LESS) radical prostatectomy (RP) has demonstrated the feasibility of the procedure. The R-LESS RP reduces some of the difficulties encountered with conventional LESS RP. Comparative investigation of traditional robotic RP is needed.