Natural orifice transluminal endoscopic surgery or NOTES refers to the conduct of minimally invasive surgery through natural orifices (like the mouth or the vagina or the nose).
In the case of radical prostatectomy the challenge has always been whether it would be possible to actually remove the prostate through a natural orifice. A team at the Mayo Clinic in Arizona is now reporting success in the surgical removal of the prostate through the patient’s urethra (the penis), thus completing an incision-free form of radical prostatectomy.
As one example, there is no specific information provided about how prostate tissues were removed, but it seems highly likely that the structure of the prostate had to be destroyed in order to “vacuum” or wash them out through the urethra, which implies that post-surgical examination of the prostate to determine its precise pathology is probably not possible after such a procedure. Historically one of the great advantages of radical prostatectomy over any other form of treatment for localized prostate cancer has been the ability to examine that prostate post-surgery to determine the precise stage and grade of the cancer. If this is not possible, why have surgery as opposed to CyberKnife radiation or brachytherapy?
The “New” Prostate Cancer InfolInk is pleased to applaud the team at the Mayo Clinic for their obvious technical skill, but we do wonder whether the small benefit of having no external scars after one’s radical prostatectomy is worth the loss of clinical certainty about the precise post-operative pathology.