Laparoendoscopic single-site surgery (LESS) prostatectomy--robotic and conventional approach

This review deals with the preliminary advances in laparoendoscopic single-site surgery (LESS) as applied to prostate surgery including the simple and radical prostatectomy approaches both robot assisted and robot independent. It analyzed current publications based on animal models and human patients. The authors searched published reports in major urological meeting abstracts, Embase and Medline (1966 to 25 August 2008), with no language restrictions. Key word searches included: "prostate", "prostatectomy", "radical", "surgery", "robot", "da Vinci", "scarless", "scar free", "single port/trocar/incision", "intraumbilical", and "transumbilical", "natural orifice transluminal endoscopic surgery" (NOTES), "SILS", "OPUS" and "LESS". The role of LESS prostatectomy with or without robotic aid has been proven to be technically feasible; however, it is important to note that the approach has significant technical challenges. The da Vinci Surgical System allows some of these ergonomic challenges to be obviated with potentially reduced instrument clash, reduced surgeon and assistant fatigue and better precision with target tasking such as performing the vesicourethral anastomosis. Preliminary consensus regarding oncological control is not yet available on a large scale. Currently, no specific advantage of the LESS approach has been convincingly proven apart from the intuitive improvement in cosmesis. The development, and soon to be launched, flexible robotic platforms towards the end of 2010 will usher with it further refinements making the LESS approach to radical prostatectomy potentially more feasible ergonomically and could see the approach gain a more widespread acceptance.