Surgery without incisions shows promise for prostate cancer treatment

With a recent first of its kind surgery, physicians at Mayo Clinic in Arizona have developed a new surgical procedure for the treatment of prostate cancer using natural orifices – signalling the next step in the evolution of minimally invasive surgery.

Removing the prostate is a common treatment for patients with prostate cancer, which affects one in six men in the US according to the American Cancer Society. Mitchell Humphreys, MD, urologist at Mayo Clinic in Arizona, said that the latest advances in the surgical treatment of the disease involve using the body’s own natural orifices as access points instead of making incisions through the skin. These types of procedures, Natural Orifice Transluminal Endoscopic Surgery, or NOTES, have advanced over the past several years and now, it is believed for the first time, a NOTES procedure has been perfected to remove the prostate.

"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," Dr Humphreys said. "To do this, we have developed specialised techniques and instruments that allow us to do all the work through the urethra, preventing the need for any incisions in the skin whatsoever."

The unique tools, developed in conjunction with Mayo Clinic in Arizona, are used in a procedure called Natural Orifice Transluminal Endoscopic Surgical Radical Prostatectomy or NOTES RP. The instruments are inserted through the penis and an innovative technique is used to remove the entire prostate. Surgeons then rejoin the internal tissues via specialised instruments 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 first patient who had a NOTES RP has done well and has had no problems or complications throughout any part of the operation in late June.

"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," Dr Humphreys said.

The recent surgery by Dr Humphreys is a culmination of more than two and a half years of research and development between James Lingeman, MD, of Indianapolis, and Jude Sauer, MD, with his research team from Rochester, New York, and the team at Mayo including Paul Andrews, MD, Chair of the Department of Urology at Mayo Clinic in Arizona.

Prostate cancer is one of the most commonly diagnosed malignancies in men. Standard surgical therapy involves removal of the prostate through open, laparoscopic, or robot-assisted laparoscopic means. Each of these approaches does the same thing by removing the entire prostate, and presumably the cancer, and then suturing (or sewing) the bladder back to the urethra to restore the continuity of the urinary system.

For decades surgical procedures have strived to become more and more minimally invasive in order to limit potential complications and speed up recovery for patients without compromising disease control. Mayo Clinic physicians in Arizona have been on the forefront of these efforts with their early involvement in laparoscopy (surgery done through multiple small incisions) and robotic-assisted surgery (using the robot system to do complex surgeries again though small incisions).

(Source: Mayo Clinic)