Surgery in Motion Safety Study of Umbilical Single-port Laparoscopic Radical Prostatectomy with a New DuoRotate System Felipe Ca ´ceres, Pedro M. Cabrera, Ana Garcı´a-Tello, Jose ´ M. Garcı´a-Mediero, Javier C. Angulo * Hospital Universitario de Getafe, Fundacio ´n para la Investigacio ´n Biome ´dica del Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain 1. Introduction Laparoendoscopic single-site surgery (LESS) is the latest progression of laparoscopic surgery. It has significantly evolved since its first urologic application, nephrectomy, was described in 2007 [1] to become, in a short time, effective and safe for many procedures and in multiple hospital settings [2]. However, its diffusion has been limited E U R O P E A N U R O L O G Y X X X ( 2 0 1 2 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europea nurology.com Article info Article history: Accepted April 22, 2012 Published online ahead of print on May 5, 2012 Keywords: LESS Prostate cancer Radical prostatectomy Single port Umbilicus Please visit www.europeanurology.com and www.urosource.com to view the accompanying video. Abstract Background: Laparoendoscopic single-site (LESS) radical prostatectomy (RP) has been performed through different approaches. A new DuoRotate manual system developed by Richard Wolf (KeyPort; Richard Wolf GmbH, Knittlingen, Germany) can be applied to RP. Objectives: Our aim was to describe the surgical technique and report early outcomes of KeyPort LESS-RP to determine if this procedure is feasible and safe. Design, setting, and participants: Prospective study performed between October 2011 and January 2012 to standardize LESS-RP. A total of 31 procedures were performed (10 with and 21 without neurovascular preservation, 8 with and 23 without pelvic lymph node dissection). Surgical procedure: LESS-RP was performed using the methods outlined in the manu- script. All patients underwent LESS RP by the same surgical team. Access was achieved via a tri-channel reusable KeyPort and one 3.5-mm extra port to facilitate urethrovesical anastomosis and drainage extraction. Outcome measurements and statistical analysis: Preoperative, perioperative, and path- ologic outcomes data are presented. Results and limitations: The mean age of the patients was 64 yr; mean body mass index: 30.7 kg/m 2 ; mean prostate-specific antigen level: 7 ng/ml; mean operative time: 207 min; and mean estimated blood loss: 258 ml. The average length of stay was 2.9 d and visual analog pain score (range: 0 [no pain] to 10) at day 2 was 1.2. Five focal positive margins (16.7%) were encountered (4.4% for pT2 and 57.1% for pT3). Five cases (16.7%) were pT2a, 3 (10%) were pT2b, 15 (50%) were pT2c, and 7 (23.3%) were pT3a. Lymph node dissection results were negative in all patients. Major complications occurred in two patients (6.5%) (hypercapnia with respiratory acidosis and rectourethral fistula) and minor complications in four (12.9%) (atrial fibrillation, orchitis, transfusion, and vomiting). No case required additional analgesia. Incision was totally hidden in the umbilicus. Study limitations included short follow-up (mean: 20.2  4.1 wk), premature functional data, and absence of a comparative cohort. Conclusions: The KeyPort system allows performance of umbilical RP with few com- plications, a low positive-margin rate, excellent aesthetic results, and very low postop- erative pain levels. # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Hospital Universitario de Getafe, Carretera de Toledo Km 12,500, 28905 Madrid, Spain. Tel. +34 699497569; Fax: +34 916247309. E-mail address: jangulo@futurnet.es (J.C. Angulo). EURURO-4503; No. of Pages 7 Please cite this article in press as: Ca ´ ceres F, et al. Safety Study of Umbilical Single-port Laparoscopic Radical Prostatectomy with a New DuoRotate System. Eur Urol (2012), http://dx.doi.org/10.1016/j.eururo.2012.04.043 0302-2838/$ – see back matter # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eururo.2012.04.043