Natural orifice (NOTES) transurethral sutureless radical prostatectomy with thulium laser support: First patient report

Introduction: The aim of this descriptive study was to demonstrate the feasibility and safety of the first true transurethral sutureless radical prostatectomy for prostate cancer in humans using the NOTES technique. Materials and methods: A 77-year-old man with clinically localized bilateral prostate cancer (Gleason 3 + 4 = 7 in 80% of 12 biopsy cores) and a serum PSA level of 2.1 ng/ml underwent our first natural orifice transurethral radical thulium laser prostatectomy within toto organ retrieval via sectio alta. The surgical procedure is described. Results: The procedure was completed successfully. Overall operation time was 312 min; laser time was 46 min with 151 KJ. Postoperative hemoglobin was 9.4 g/dl, and the hematocrit was 28%. A cystogram on the 7th postoperative day showed no signs of extravasation and the transurethral catheter was removed, and a flexible cystoscopy on the 9th day demonstrated a sufficient arbitrarily sphincter closure against irrigation flow. Conclusion: The presented descriptive report demonstrates that natural orifice transurethral radical thulium laser prostatectomy for prostate cancer is feasible and safe. Potential candidates include older patients with low-risk cancers and urinary obstruction. Further prospective reports are necessary to evaluate functional and oncological outcome for this innovative technique.