LESS: Radical prostatectomy

Abstract

In the last two decades, urologists and patients have witnessed a technological revolution in urology caused by laparoscopy and robotics. The surgical treatment of prostate cancer is probably the main example of this change. More recently, laparoendoscopic single-site (LESS) surgery, also known as single-port laparoscopy (SPL), and natural orifice translumenal endoscopic surgery (NOTES) turned into reality the ideal of surgery with minimal or no scar. Despite promising early outcomes, these techniques worsened the ergonomics and increased the learning curve for surgeons. The technical restraints limit the applicability of LESS to a selected group of patients. Although the number of reports has increased dramatically worldwide in recent years, few surgical centers perform LESS regularly. Robotic LESS (R-LESS) refers to the application of robotic technology to LESS and is one of the possible solutions found to overcome some of the limitations inherent to LESS and NOTES. Even though significant ergonomic and technical improvements were perceived with this convergence, the robotic platform currently available was not designed for LESS. Research is ongoing, and hopefully new robotic systems will fulfill this gap, possibly making these techniques available to a larger number of patients and surgeons. In this chapter, we describe our experience and review the literature available on LESS and R-LESS radical prostatectomy. We emphasize the technical aspects of R-LESS, which became our preferred technique for the treatment of adenocarcinoma of the prostate in patients who are eligible for minimally invasive surgery through a single skin incision.