Laparoscopic radical prostatectomy with flexible instruments and 3D imaging: An alternative to traditional robotic platforms

Objective: To report a laparoscopic radical prostatectomy utilizing a three-dimensional (3D) camera and flexible instruments in a patient with localized prostate cancer. Patient and Surgical Procedure: The procedure employed the Endoeye® Flex 3D system (Olympus, PA, USA) and ArtiSential flexible instruments. It included transperitoneal extended pelvic lymphadenectomy, followed by anterograde prostate dissection, reconstruction of the vesical neck, and urethrovesical anastomosis. Both the surgeon and assistant wore 3D glasses. Results: 3D imaging provided excellent surgical field visualization, while flexible instruments facilitated tissue dissection and urethrovesical anastomosis. The use of 3D glasses and perception was well-tolerated by the surgeon. No intraoperative or immediate postoperative complications were reported. Pathological examination revealed a Gleason score of 4 + 4 adenocarcinoma with negative margins and no evidence of lymph node metastasis. At the six-month follow-up, the patient remained continent and demonstrated adequate biochemical control. Conclusions: Combining a 3D camera with flexible instruments during laparoscopic radical prostatectomy offers benefits comparable to robotic surgery. This presents a valid alternative for centers where the cost of robotic systems may be a limitation.