Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have beenfocused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stageconsidering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery,using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) andconventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma andevaluated the potential advantages of each. Materials and
Methods: From January 2010 to December 2010, all 23patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introducedthe reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stageprostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serumPSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates andpost-operative pain.
Results: There was a significant difference in operative time between the 2-port RP andLRP groups (286.5±63.3 and 351.8±72.4 min: p=0.0019, without any variation in blood loss (including urine)(945.1±479.6 vs 1271.1±871.8ml: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RPgroup, but without significance (5.6±1.8 vs 8.0±5.6 days: p=0.057) and the total perioperative complication ratesfor 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-freerates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients(95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodiumwas 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP.
Conclusions: Thus the reduced port approach isas efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reductionin post surgical pain. This method can be readily performed safely and therefore can be recommended as astandard laparoscopic surgery for prostate cancer in the future.