The major disadvantage of Radical Perineal Prostatectomy (RPP) is the difficulty to perform pelvic lymphadenectomy via the same incision. Open retropubic, Mini Laparotomy and Transperitoneal Laparoscopic Lymphadenectomy as an adjunct to open RPP have been tried but are associated with increased morbidity and operative time. Open RPP followed by Lap Perineal pelvic lymphadenectomy via the same perineal incision of open RPP using the Single Incision Laparoscopic Surgery (SILS) is a new hybrid technique with very low morbidity and comparable outcome

Study Design: Prospective Observational Study
Materials and Methods: Patients of low and intermediate-risk localized carcinoma prostate were taken for this procedure. After completing the prostatectomy part of RPP, Lap Perineal Pelvic Lymphadenectomy was performed via the same incision using the SILS port. The urethra-vesical anastomosis was then done via open technique after removing the SILS port. Operative time, blood loss, number of nodes removed and complications, were recorded and analyzed. Lymphocele was evaluated at 3 months with CT pelvis.

RPP required a mean operative time of 180 minutes including a mean operative time of 35 minutes for lymphadenectomy. The mean number of lymph nodes removed from the 8 patients was 8.4 (range 4 to 12) and the total number of nodes retrieved was 68. No major bleeding or complications like lymphocele occurred.1 patient needed a blood transfusion and one patient had a perineal wound infection which was managed conservatively. None of our patients had rectal injury. The operative outcomes are given in table 3.

The total number of nodes retrieved                                                 	               68
Mean No of lymph nodes retrieved                                             	                       8.4 (4-12)
Number of positive Lymph nodes                                               	                       0
Mean total operative time (including lymphadenectomy), minutes     	       180 (120-250)
Mean operative time for Lymphadenectomy, minutes, range	                       35 (30-45)
Mean operative blood loss, mL, range                                                         	       350 (280-420)
Wound infection                                                                            	                       1
Lymphocele 	                                                                                                               0
Rectal injury                                                                                  	                       0
Transfusion	                                                                                                               1

The Lap Perineal Pelvic Lymph node dissection via the same incision of RPP using SILS port after prostatectomy offers a viable surgical alternative to the usual methods of pelvic lymph node dissection and aims at extending the scope of RPP. It is safe, feasible, efficient, and is not associated with an increase in morbidity, operative time, or perioperative complications. The learning curve is short and the major disadvantage of second access for lymph node dissection can thus be resolved. This hybrid technique can be a landmark achievement in expanding the horizon of RPP and this concept can be further expanded to the similar hybrid technique of open RPP with robotic perineal lymphadenectomy.