Single‐port transvesical enucleation of the prostate: a clinical report of 34 cases

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To present our experience with single‐port transvesical enucleation of the prostate (STEP) in 34 patients with large‐volume benign prostatic hyperplasia (BPH). PATIENTS AND METHODS We performed STEP in 34 patients with large volume (>60 g) BPH (mean age 69 years, body mass index 26 kg/m2, and American Society of Anesthesiology class 2). The mean prostate volume estimated by transrectal ultrasonography was 102.5 mL and the mean baseline prostate‐specific antigen level was 6.7 ng/mL. A novel single‐port device was inserted percutaneously into the bladder through a 2–3 cm incision in the suprapubic skin crease. After establishing pneumovesicum, the prostate adenoma was enucleated transvesically using standard laparoscopic instruments, and the adenoma was extracted in pieces through the port. Digital assistance expedited enucleation of the apical adenoma in 19 (55%) cases. RESULTS Transvesical enucleation was completed in all 34 cases; the mean operative duration was 116 min, and the estimated blood loss was 460 mL. There was one death from postoperative bleeding from uncontrolled coagulopathy in a Jehovah’s Witness who refused a transfusion of blood and blood products. There were three complications during STEP (one death, one bowel injury and one haemorrhage) and five afterwards (four bleeding, one epididymo‐orchitis). Open conversion was necessary in two patients for complications, and extension of the skin incision by 1–2 cm was necessary in two to expedite apical digital enucleation. The mean hospital stay was 3 days and mean analogue pain score at discharge was 2. All 33 patients (excluding the patient who died) were voiding spontaneously at a maximum follow‐up of 8 months, with a mean American Urologic Association symptom score of 3, a maximum urinary flow rate of 44 mL/s, and a postvoid residual of 30 mL at the latest follow‐up. No patient developed urinary incontinence. CONCLUSIONS STEP is an effective treatment option for selected patients with large‐volume obstructive BPH. Under pneumovesicum using laparoscopic visualization, the entire adenoma can be effectively enucleated and expeditiously extracted through the novel single port. Comparison of the STEP procedure with other open and transurethral techniques will determine its place in the surgical treatment of large‐volume BPH.

Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature

“…Sotelo and his group also detailed their technique of the simple prostatectomy using a single multilumen port [58]. More recently, these two groups of investigators jointly presented their cumulative multi-institutional series of STEP in 34 patients [59]. Digital adenoma enucleation was used in 19 (55%) cases.…”

“…Medium Risk for prolonged warm ischemia time. Simple prostatectomy [57][58][59] Very difficult Availability of other, established techniques (eg, TURP, HoLEP, PVP).…”

Laparoscopic nephroureterectomy with transvesical single-port distal ureter and bladder cuff dissection: points of technique and initial surgical outcomes with five patients.

“…The most interesting techniques seem to be those using transvesical single access systems and establishing a pneumovesicum. To date, simple prostatectomies, diverticulectomies, foreign body removals and ureteral reimplantation have been performed using transvesical laparoendoscopic single-site surgery (T-LESS) [21–24]. The T-LESS approach was combined with LNU first by Sotelo et al .…”

Laparoscopic Simple Prostatectomy

“…tek porttan robotik prostatektomi uygulanan 34 hastalık serilerini bildirmişler ve büyük hacimli prostatların cerrahi tedavisinde tek porttan robotik basit prostatektominin başarılı bir yöntem olduğunu belirtmişlerdir (39). Bu çalışmalarında; cerrahi sırasında bir hastanın öldüğünü, bir hastada barsak yaralanması geliştiğini ve bir hastada da kanama olduğunu belirtilmiştir.…”