Our Summary

This research paper reviews existing studies on a surgical method called single port radical prostatectomy (LESS-RP). This is a procedure where prostate surgery is performed through a single, small incision. It’s been a challenging development for the world of urology, as there are different ways to approach this surgery - from the front (transperitoneal), from the back (extraperitoneal), or through the bladder (transvesical). To make this procedure better, new tools, visual aids, and retraction mechanisms have been invented.

Opinions on LESS-RP are divided. Some argue that it’s unreliable due to the small number of cases and its technical difficulty. Others, on the other hand, believe that despite these challenges, the procedure has shown benefits. They claim that the difficulties are being overcome, especially with the introduction of a new robotic system, the Da Vinci SP, which is being integrated into the procedure.

The LESS-RP approach is seen as a new frontier in prostate surgery, and could lead to a standardized technique. But there are only a few studies available on it, likely due to its technical complexity and the reluctance to apply it. However, the introduction of the Da Vinci SP robotic system shows that advancements in surgical technology are happening, and it’s important to keep up with these changes.

FAQs

  1. What is single port radical prostatectomy (LESS-RP)?
  2. What are the challenges associated with the LESS-RP procedure?
  3. How does the Da Vinci SP robotic system improve the LESS-RP procedure?

Doctor’s Tip

A doctor may advise a patient undergoing a prostatectomy to inquire about the possibility of a single port radical prostatectomy (LESS-RP) as a potential option. They may recommend discussing the benefits and risks of this procedure with their healthcare provider to determine if it is suitable for their individual case. It’s important to stay informed about advancements in surgical technology, such as the Da Vinci SP robotic system, and to explore all available options for the best possible outcome.

Suitable For

Patients who are typically recommended for prostatectomy are those with localized prostate cancer that has not spread beyond the prostate gland. This includes patients with a PSA (prostate-specific antigen) level greater than 10 ng/mL, a Gleason score of 7 or higher, and a life expectancy of at least 10 years. Additionally, patients who are younger, have good overall health, and are willing to undergo surgery are also good candidates for prostatectomy.

It is important for patients to discuss the risks and benefits of prostatectomy with their healthcare provider to determine if it is the best treatment option for them. Additionally, the type of prostatectomy recommended may vary based on the patient’s individual circumstances and the expertise of the surgical team.

Timeline

Before prostatectomy:

  1. Patient is diagnosed with prostate cancer through a biopsy or other diagnostic tests.
  2. Patient consults with urologist to discuss treatment options, including prostatectomy.
  3. Patient undergoes pre-operative testing, such as blood tests, imaging scans, and possibly a colonoscopy.
  4. Patient may undergo hormone therapy or other treatments to shrink the prostate before surgery.
  5. Patient undergoes counseling and education on what to expect before, during, and after the surgery.

After prostatectomy:

  1. Patient is admitted to the hospital for the surgery.
  2. Surgery is performed, either through traditional open surgery, laparoscopic surgery, or robotic-assisted surgery.
  3. Patient stays in the hospital for a few days for recovery and monitoring.
  4. Patient may experience pain, discomfort, and urinary incontinence after surgery.
  5. Patient undergoes physical therapy and rehabilitation to regain strength and function.
  6. Patient may experience changes in sexual function, such as erectile dysfunction.
  7. Patient follows up with urologist for monitoring and further treatment as needed.

What to Ask Your Doctor

Some questions a patient should ask their doctor about prostatectomy include:

  1. What are the different types of prostatectomy procedures available, and why do you recommend a single port radical prostatectomy (LESS-RP) for me?
  2. What are the potential risks and complications associated with LESS-RP compared to traditional prostatectomy methods?
  3. How experienced are you in performing LESS-RP procedures, and what is your success rate?
  4. What is the recovery process like for LESS-RP compared to other prostatectomy techniques?
  5. Are there any long-term effects or considerations I should be aware of after undergoing a LESS-RP procedure?
  6. Are there any alternative treatment options to consider before proceeding with a prostatectomy?
  7. How will the Da Vinci SP robotic system enhance the LESS-RP procedure, and what benefits does it offer?
  8. Will I need any additional follow-up care or monitoring after undergoing a LESS-RP procedure?
  9. What can I expect in terms of pain management and post-operative care following the surgery?
  10. How soon after the procedure can I expect to return to normal activities and resume my usual lifestyle?

Reference

Authors: Martín OD, Azhar RA, Clavijo R, Gidelman C, Medina L, Troche NR, Brunacci L, Sotelo R. Journal: J Robot Surg. 2016 Jun;10(2):87-95. doi: 10.1007/s11701-016-0589-5. Epub 2016 Apr 12. PMID: 27072150