Related Experiment Video
Updated: Jun 10, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
'LESS' radical prostatectomy: a pilot feasibility study with a personal original technique
Franco Gaboardi1, Andrea Gregori, Luigi Santoro
1Department of Urologic Surgery, 'Luigi Sacco' University Medical Center, Milan, Italy.
Objective:
We evaluated the feasibility and the potential advantages of a modification of the single-port laparoscopic radical prostatectomy using a periumbilical multichannel port plus a second port placed in the left fossa with the aim of having an adequate working angle during the most critical steps of the procedure.
Patients And Methods:
Between March and September 2009 we operated on five patients with early-stage prostate cancer (T1c) and a normal body mass index (<25). The procedure was carried out with a specially-designed multichannel trocar which contains two 5 mm and one 10 mm ports plus a 5 mm port placed in the left iliac fossa in order to have an adequate working angle. The first two patients received a nerve sparing radical prostatectomy.
Results:
All cases were completed successfully in a mean operative time of 225 minutes (range 210-250) with blood losses of less than 100 ml. All patients were discharged from the hospital in 3rd postoperative day and the catheter was always removed seven days from surgery. No intraoperative complications occurred. The pathological tumour stage revealed pT2bNo prostate cancer in all five cases without positive surgical margins. After a mean follow-up of 4 months (range 1-7) all patients have an undetectable prostate-specific antigen level and no postoperative early major complications. The first two patients were fully continent respectively after 3 and 8 weeks after surgery, the third patient uses one safety pad after three month from surgery. The last two patients have a moderate incontinence and are currently under rehabilitation. Regarding potency the first patient had intercourses without any therapies after two months from surgery while the second one (6 months follow up) has partial penile tumescence using oral vardenafil.
Conclusion:
Two ports laparoscopic radical prostatectomy is feasible in very selected cases. However, our pilot study should be still considered a technical report and the limits of the technique must still be defined in a larger population and by other investigators.
Insights
This study explored a modified two-port laparoscopic radical prostatectomy for early-stage prostate cancer. The technique proved feasible in select cases, offering potential advantages for surgical angles.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Radical prostatectomy is a standard treatment for prostate cancer.
- Single-port laparoscopic surgery aims to minimize invasiveness.
- Achieving optimal working angles in laparoscopic prostatectomy can be challenging.
Purpose of the Study:
- To evaluate the feasibility and benefits of a modified two-port laparoscopic radical prostatectomy.
- To assess a technique using a periumbilical multichannel port and a left iliac fossa port.
- To determine if this approach provides an adequate working angle for critical surgical steps.
Main Methods:
- Five patients with early-stage prostate cancer (T1c) and normal BMI underwent the procedure.
- A multichannel trocar (two 5 mm, one 10 mm) and a 5 mm left iliac fossa port were used.
- Nerve-sparing radical prostatectomy was performed in the first two patients.
Main Results:
- All five procedures were completed successfully with a mean operative time of 225 minutes and minimal blood loss (<100 ml).
- No intraoperative complications occurred; patients were discharged on postoperative day 3.
- Pathological staging confirmed pT2bNo prostate cancer without positive margins in all cases.
- At a mean follow-up of 4 months, all patients had undetectable PSA levels.
- Functional outcomes showed varying degrees of urinary continence and erectile function recovery.
Conclusions:
- Two-port laparoscopic radical prostatectomy is feasible in carefully selected patients.
- This pilot study is a technical report, and further investigation is needed.
- Larger studies are required to define the technique's limitations and broader applicability.
