Robotic Laparoendoscopic Single-Site Radical Prostatectomy

Abstract

Laparoendoscopic single-site surgery (LESS) can be regarded as the latest progression in laparoscopic surgery and has garnered much enthusiasm. LESS is evolving, and robotic assistance and other technical developments may well lead to its further advancement. Early clinical experiences with LESS have pointed out several limitations related to technical constraints, including lack of triangulation, clashing of instruments, and limited operating space. To help overcome these limitations, the da Vinci surgical system has been applied to LESS and termed robotic LESS (R-LESS) (Desai et al., BJU Int 102:1666–1669, 2008; Kaouk et al., BJU Int 103:366–369, 2009; Barret et al., J Endourol 23:135–140, 2009; Kaouk and Goel, Eur Urol 55:1163–1170, 2009; Stein et al., Eur Urol 57:132–137, 2010; Barret et al., Int Braz J Urol, 2009).

Kaouk et al. first reported an initial feasibility study of LESS radical prostatectomy (RP) in humans (Kaouk et al., Urology 72:1190–1193, 2008). At that time, the authors acknowledged the limitation of embarking on this procedure due to challenges related to ergonomics and intracorporeal suturing, and they claimed a potential application of robotics. This chapter will detail R-LESS RP in a comprehensive description. The aim is to demonstrate the procedure by describing the technique.