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First single-port prostatectomy and cystectomy performed

The world’s first radical prostatectomy and radical urinary cystectomy (cystoprostatectomy) entirely through a single incision in the navel has been perfomed – theoretically paving the way for similar pioneering surgery in Europe.

The procedures were carried out by Jihad H Kaouk, MD, Director of Robotic Urologic Surgery at Cleveland Clinic and a pioneer of Single-Port Laparoscopic (SPL) methodology in the field of urology.

The conventional laparoscopic approach to radical prostatectomy for prostate cancer and cystoprostatectomy for bladder cancer utilises five or six abdominal wall incisions.

The true SPL trans-umbilical approach employed by Dr Kaouk is a variant of the laparoscopic operation that uses only a single small umbilical incision through which a single specially-designed port is placed. There is no utilisation of any other accessory ports inside or outside the umbilicus.

Dr Kaouk has successfully performed more than 25 urological reconstructive, ablative and excisional operations with this new approach. These procedures include the first SPL radical prostatectomy, radical urinary cystectomy, trans-abdominal sacral colpopexy for vaginal prolapse, kidney tumour cryoablation and radical nephrectomy.

Dr Kaouk also used the single port technique to perform the first single port retroperitoneal kidney surgery and single port laparoscopic pediatric surgery.

The Uni-X Single Port Laparoscopic System, among other instrumentation, was employed during these operations.

So far, no intra-operative or postoperative complications have been observed. There were no conversions to conventional laparoscopic approaches or to traditional open procedures.

The initial experience in SPL by Dr Kaouk and his colleagues at the Cleveland Clinic will be presented at the American Urological Association in May 2008.

This ground-breaking clinical work in SPL will be published in an upcoming issue of Urology Times. This represents the first peer-reviewed article on the first accomplished cases in SPL in urology. It also includes the largest experience in ablative and reconstructive single port surgery where all instruments used were passed through the single port without the use of any 2mm or 3mm instruments for retraction or assistance.

“Although more clinical experience and scientific studies are required in order to define the patient and health care benefits, the SPL has the potential of improving the patient’s outcomes and saving health care dollars,” Dr Kaouk.

Cleveland Clinic