Articles

Safety Study of Umbilical Single-port Laparoscopic Radical Prostatectomy with a New DuoRotate System

By: Felipe Cáceres, Pedro M. Cabrera, Ana García-Tello, José M. García-Mediero and Javier C. Angulolowast

Published online: 01 December 2012

Keywords: LESS, Prostate cancer, Radical prostatectomy, Single port, Umbilicus

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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.

Objectives

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.

Design, setting, and participants

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).

Surgical procedure

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.

Outcome measurements and statistical analysis

Preoperative, perioperative, and pathologic outcomes data are presented.

Results and limitations

The mean age of the patients was 64 yr; mean body mass index: 30.7kg/m2; mean prostate-specific antigen level: 7 ng/ml; mean operative time: 207min; and mean estimated blood loss: 258ml. 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.

Take Home Message

Laparoscopic radical prostatectomy can be performed through a new, umbilical, reusable, single-port system that incorporates DuoRotate Instruments and confers an economical advantage with very good operative parameters, pathologic outcomes for cancer control, cosmetic results, and postoperative analgesia.

Keywords: LESS, Prostate cancer, Radical prostatectomy, Single port, Umbilicus.

Footnotes

Hospital Universitario de Getafe, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain

lowast Corresponding author. Hospital Universitario de Getafe, Carretera de Toledo Km 12,500, 28905 Madrid, Spain. Tel. +34 699497569; Fax: +34 916247309.