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Re: Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study




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Letter to the Editor

Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study

Sir,

We read the article by Su et al describing a new and innovative Zhu‘s transurethral port for performing transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy [1]. We appreciate the authors’ innovation in making LESS urological surgery feasible and simplifying the technically demanding lower tract procedures by the use of a natural urethral orifice as the site of the second port.

However, a few points need due consideration. In the video and the article, details of inserting the Zhu’s port and its use in urethro-vesical suturing are omitted. This detail will be of great benefit to the readers for reproduction of this technique.

From the available literature it has been clear that the urethral stricture rate after transurethral resection of prostate is dependent upon the duration of the procedure (>60 minutes) and the size of the resectoscope used [2, 3]. Similarly, use of an outer sheath of the resectosope of 25.6 Fr by the authors in urethra for such prolonged durations (mean duration of procedures 152 to 328 minutes) may lead to stricture formation [1]. It will be beneficial to know the actual indwelling time of Zhu’s port during the surgery and rate of urethral strictures encountered in long term follow up of these patients.

The use of harmonic scalpel or such energy devices for lateral pedicle dissection in radical prostatectomy have been fraught with a higher risk of erectile dysfunction [4]. The use of a cauterizing device with an inability to perform nerve sparing procedures seems to be another drawback of the use of Zhu’s technique. It will be beneficial to the readers if the authors can mention the rate of erectile dysfunction in their cohort.

 

Read the article

 

Tushit Rai, MBBS, MS

Senior Resident, Department of Urology, PGIMER, Chandigarh

 

Aditya Prakash Sharma, MS, M.Ch

Assistant Professor, Department of Urology, PGIMER, Chandigarh

 

Shrawan K Singh, MS, M.Ch.

Professor, Department of Urology, PGIMER, Chandigarh

 

References

  1. Su J, Zhu Q, Yuan L, Zhang Y, Zhang Q, Wei Y. Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study. BJU Int 2018; 121(1): 111-8.
  2. Chen ML, Correa AF, Santucci RA. Urethral Strictures and Stenoses Caused by Prostate Therapy. Rev Urol 2016; 18(2): 90-102.
  3. Grechenkov AS, Glybochko PV, Alyaev YG, Bezrukov EA, Vinarov AZ, Butnaru DV, Sukhanov RB. Risk factors for anterior urethral strictures after transurethral resection of benign prostatic hyperplasia.[Article in Russian]. Urologiia 2015; 1: 62-5.
  4. Hefermehl LJ, Largo RA, Hermanns T, Poyet C, Sulser T, Eberli D. Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery. BJU Int 2014; 114(2): 245-52.

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