Incisionless Surgery Shows Promise in Prostate Cancer Treatment

A new surgical procedure for the treatment of prostate cancer uses surgical instruments inserted through the penis, signaling the next step in the evolution of minimally invasive surgery.

Researchers at the Mayo Clinic (Scottsdale, AZ, USA) have developed special tools to allow natural orifice transluminal endoscopic surgical (NOTES) removal of the prostate, naming the procedure NOTES radical prostatectomy (NOTES RP). The instruments are inserted through the urethra, and an innovative technique is used to remove the entire prostate. Surgeons then rejoin the internal tissues via specialized instruments that are also designed to work through the urethra. Patients benefit from the procedure because there are no incisions, little risk of bleeding, and are usually able to leave the hospital within 24 hours.

The procedure involves a 100 W holmium:yttrium-aluminum-garnet laser with a 550 μm end-firing laser fiber, a 26F resectoscope, a 7F laser stabilizing catheter, and continuous irrigation. The surgeons first radically resect the prostate with the lasers; the tissue is then removed endoscopically with a tissue morcellator and delivered into the bladder. The first patient to undergo the NOTES RP procedure at the Mayo Clinic was released in June 2010, and suffered no complications throughout any part of the operation.

"The reason this hasn't been done in prostate surgery before is because of the challenge of rejoining or suturing the bladder back to the urethra,” said urologist Mitchell Humphreys, M.D., of the Mayo Clinic. "This really shows that the impossible is now possible, and represents a paradigm shift not only in the way we look at diseases, but also how we surgically treat disease.”

Standard surgical therapy for prostate cancer--one of the most commonly diagnosed malignancies in men--involves removal of the prostate through open, laparoscopic, or robot-assisted laparoscopic means. Each of these approaches involves removes the entire prostate, and presumably the cancer, and then suturing the bladder back to the urethra to restore the continuity of the urinary system.

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