Authors: René Sotelo, Robert De Andrade, Oswaldo Carmona, Golena Fernández, Rafael Clavijo, Camilo Guidelman, Robert Garza, Juan Castro, Mihir Desai.
Technique: Single Port Transumbical Simple prostactectomy was performed using a single multilumen port. Standard laparoscopic ultrasonic shears and needle drivers, an articulating scissors and specifically designer bent grasping instruments facilitated dissection and suturing.
Laparoscopic technique: Umbilical incision. Single port placement. Transverse cystotomy. Retraction of the median lobe. Development of the subcapsular plane. Enucleation of the adenoma. Cystotomy closure. A closed suction drain was externalized through the umbilical incision.
Advantages: No extraumbilical skin incisions. Reduced blood loss and transfusions. Shorter hospitalization.
Results: No intraoperative and complications occurred. Hospital stay was two days. The retropubic drain was removed at three and the catheter at one week. The r-port was placed through a 2cm intraumbilical incision. Specimen weight was 95 grams. The scar is concealed with the umbilicus, and the patient is continent and voiding spontaneously.
Conclusions: Our preliminary experience with E-NOTES simple prostatectomy is encouraging. After overcoming the technical challenges of single-port multilumen access, precise tissue dissection could be perform akin to standard laparoscopy. The procedure was technically difficult compared to the standard laparoscopic technique due to instrument crowding. Prospective matched-pair comparison with laparoscopic simple prostatectomy is ongoing to determine, apart from technical feasibility and improved cosmesis, whether decreased morbidity is achieved.