Desai MM et al. (2009) Single-port transvesical simple prostatectomy: initial clinical report. Urology 72: 960–965

A preliminary study has revealed that a minimally invasive single-keyhole surgery technique is technically feasible for the removal of large prostates. Desai and colleagues report on the initial outcomes of single-port transvesical enucleation of the prostate as an alternative method to invasive surgical enucleation of prostates greater than 80 g in size.

The procedure was performed in three patients aged 82, 70, and 78 years with large-volume benign prostatic hyperplasia (prostate sizes 187, 93, and 92 g, respectively). A novel single-port device was used to access the bladder via a small incision (2.5 cm). The prostate adenoma was enucleated and divided intravesically into two or three pieces to allow removal through the incision.

Removal of the prostatic adenoma was successful in all three patients. A bowel injury occurred in the first patient during insertion of the single-port device near the umbilicus. This injury was repaired after enucleation. The incision was made between the umbilicus and symphysis in the second and third patients. After catheter removal (within 8 days of the procedure), all patients were able to urinate without difficulty and none suffered from incontinence.

Desai et al. highlight a number of theoretical advantages of single-port transvesical enucleation over surgical removal of the prostate: the whole adenoma can be enucleated and removal of the adenoma is easy; the risk of urethral strictures is minimized as urethral instrumentation is minimal; the absence of irrigation fluid potentially reduces the risk of infection; and bleeding can be monitored by means of a small endoscope.