Natural orifice transluminal endoscopic radical prostatectomy: initial perioperative and pathologic results

Abstract

Urological Survey 786would likely decrease the risk of unnecessary anesthesia. For patients who cannot reliably strain their urine, reimaging with a low-dose CT pelvis should be seriously considered for those patients with distal ureteral calculi ≤ 5mm in size. Objective: To describe the first clinical experience, pathologic, and perioperative outcomes of natural orifice transluminal endoscopic surgery (NOTES) radical prostatectomy. NOTES represents the evolution of minimally invasive surgery. The conceptual feasibility has been shown in careful laboratory and animal studies, but a scarcity of information regarding clinical applications exists. Methods: After institutional review board approval, 2 patients agreed to undergo NOTES radical prostatectomy for localized prostate cancer. The prostate was radically resected using a 26F resectoscope, 550-µm laser fiber, and holmium laser. The prostate was delivered into the bladder and removed at the conclusion of the procedure through a suprapubic cystotomy for histopathologic analysis. The vesicourethral anastomosis was completed using a cannula scope, urethral-vesical suturing device, and titanium knot applier. Cystograms were taken immediately postoperatively and at catheter removal. Results: Both patients tolerated the procedure without operative complications. All intraoperative cystograms showed watertight anastomoses. The pathologic examination revealed Gleason score 3 + 3 and Stage pT2aNx-Mx for 1 patient and Gleason score 3 + 4 and Stage pT2cNxMx for 1 patient, with negative margins for both. No blood transfusions were required. Patient 2 experienced some left-sided gluteal and suprapubic pain postoperatively. Conclusion: NOTES radical prostatectomy appears to be a safe and feasible option for the management of carefully selected, organ-confined prostate cancer. The perioperative and pathologic outcomes show promise with this new technique; however, the high standards of oncologic and functional outcomes demand close and longer follow-up before adoption into the surgical armamentarium can be recommended. Dr. Manoj Monga Editorial CommentThe authors must be congratulated for their pioneer work. The advancement of minimally invasive urological surgery has pushed the technology and surgical instruments industry to collaborate with surgeons allowing better care of our patients.

The transrectal single port laparoscopic radical prostatectomy in a cadaver model

“…Depending on the technique, NOTES transurethral prostatectomy, either requires morcellation [19] of the specimen or additional skin incision for the specimen extraction. [3] Morcellation is contradictory to oncological principles. On the other hand, creating additional skin incisions moves away from the principle of NOTES and should be considered a hybrid technique.…”

“…[2] A transurethral approach has been previously described for NOTES radical prostatectomy. [3] The transrectal NOTES route has been explored for nephrectomy to date. [4] Given previous experience matured at our center with endoscope-assisted radical perineal prostatectomy (RPP), [5,6] we aimed to explore the technical feasibility of transrectal radical prostatectomy (TRRP) in a cadaveric model and to outline the surgical anatomy of prostate and its surrounding structures when using a transrectal NOTES route.…”

Recent advances in urologic laparoscopic surgeries: laparoendoscopic single‐site surgery, natural orifice transluminal endoscopic surgery, robotics and navigation

“…In 2011, Humphreys et al . reported a transurethral NOTES radical prostatectomy with resection of the prostate using a holmium laser in which the bladder neck and urethra were anastomosed together with a specially designed transurethral instrument . Holmium laser transurethral prostatectomy for benign hypertrophy is widely performed all over the world, and the technical demands of transurethral NOTES prostatectomy may not be difficult for experienced surgeons, except for the transurethral anastomosis of the bladder and urethra.…”

“…The small caliber of the urethra is the primary limitation of transurethral NOTES and may restrict the use of some instruments and organ retrieval. A prostate resected by NOTES radical prostatectomy was removed through a suprapubic cystotomy with an abdominal stab wound to get an accurate pathological diagnosis . Further instrument development is necessary for the wide application of transurethral–transvesical NOTES.…”

The transrectal single-port laparoscopic radical prostatectomy in a cadaver model

“…Humphreys et al [6] introduced another innovative surgical technique called NOTES radical prostatectomy for localized prostate cancer via a transurethral approach. This technique has the same advantages as transrectal NOTES radical prostatectomy, such as minimal invasiviness and improved cosmetic outcomes, with the lack of potential risks seen rectal injury.…”