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Laparoendoscopic radical prostatectomy (LRP): stepwise transition from multi-site to single-site with the aid of the transurethral port

  • Urology - Original Paper
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Abstract

Purpose

To describe our initial experience with laparoendoscopic radical prostatectomy (LRP) and a stepwise transition towards transurethral assisted laparoendoscopic single-site RP (TU-LESS RP).

Patients and methods

From Jan. 2007 to Dec. 2016, 195 patients underwent RP, of which 89 patients were performed by LRP (Group A), 106 by TU-LESS RP (Group B). The peri-operative data were collected and analyzed. All data referring to patient demographics, surgery, pathology, and peri-operative outcomes were recorded. The cosmetic result was investigated by the Patient Scar Assessment Questionnaire (PSAQ). Analysis of variance or Chi squared test were adopted to analyze the data.

Results

195 procedures were completed successfully. The operation time (109.6 ± 31.9 vs. 151.5 ± 87.3, P = 0.025) and anastomosis time (10.1 ± 4.8 vs. 21.8 ± 9.9, P < 0.001) of Group B was significantly reduced compared with Group A. Estimated blood loss in Group B was significantly lower than that in Group A (95.9 ± 11.1 vs. 180.2 ± 99.7, P = 0.006). About perioperative complications, Group B was also less compared with Group A (1.9% vs. 7.9%, P = 0.047). As to the usage of postoperative analgesics, Group B apparently used less than that in Group A (6.6% vs. 62.9%, P < 0.001), which is consistent with the visual analogue scale (VAS) of the two groups (1.7 ± 1.3 vs. 7.8 ± 1.1, P < 0.001). Patients in Group B were significantly more satisfied with incision healing than in group A (74.9 ± 9.3 vs. 49.7 ± 5.8, P < 0.001). There was no significant difference both in BCR rate and time between Group B and Group A. In urination control, more patients in Group B did not have urinary incontinence 3 month after RP compared with Group A (81.1% vs. 67.4%, P = 0.028).

Conclusions

LESS RP is proved to be feasible for the proper patients, but it is difficult to popularized due to inconvenient operation. While by means of TU-LESS, operating difficulty can be significantly decreased. TU-LESS RP will be wildly accepted by surgeons and patients because of cosmetic satisfaction and quicker recovery.

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Acknowledgements

The hand-drawn illustrations in this article were drawn by Leizi medical art studio of Nanjing Medical University.

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Author notes

  1. Yunfei Wei and Jingyuan Tang contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China

    Yunfei Wei, Jingyuan Tang, Lin Yuan, Jian Su, Yang Zhang, Zhonglei Deng, Chen Zhu, Luming Shen, Ninghong Wang, Guojiang Xu & Qingyi Zhu

  2. Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China

    Yong Yang

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Contributions

YFW and JYT: project development, data analysis, manuscript writing. LY, JS, YZ, ZLD, CZ and LMS: data collection, data analysis, manuscript writing. NHW, GJX, YY and QYZ: critical revision of the manuscript.

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Correspondence to Qingyi Zhu.

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All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Wei, Y., Tang, J., Yuan, L. et al. Laparoendoscopic radical prostatectomy (LRP): stepwise transition from multi-site to single-site with the aid of the transurethral port. Int Urol Nephrol 53, 249–255 (2021). https://doi.org/10.1007/s11255-020-02638-0

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