Laparoscopic adenectomy: a novel technique for managing benign prostatic hyperplasia

Abstract

The prostatic capsule is opened 3-4 cm transversally according to prostate size. Haemostatic sutures are placed at the 5 and 7 o'clock positions. Coagulation is obtained by bipolar diathermy. For the first three patients the right index finger was introduced through a 2-cm suprapubic incision into the capsule, permitting enucleation of the adenoma as with the open technique (Fig. 3). After closing the incision, CO 2 was again insufflated to control the section of the adenoma at the apex, which is always visible with the laparoscope. For the last two patients, enucleation was entirely under laparoscopic control without using the finger. The specimen was then placed in the lateral prostatic fossa to await removal. A 22 F irrigation catheter is then introduced (Fig. 4) and a running suture of 2-0 polyglactin used to close the prostatic capsule (Fig. 5). A suction drain is placed in the Retzius space by a lateral trocar. The bladder is irrigated as before with a saline solution. At the end of the procedure, the specimen is placed in a laparoscopic bag and extracted through the enlarged umbilical incision.In the five patients the adenoma was > 120 g in three and 60-120 g in the other two. The median (range) operative duration was 95 (125-55) min (55 for the last two interventions). After surgery no opioids were necessary; the urethral catheter was removed on the third day in all patients, with a return home the day after, with normal continence. No prostatic adenocarcinoma was encountered at the pathological examination. There was no blood transfusion or infection reported. COMPARISON WITH OTHER METHODSMany approaches for BPH of > 60 g have been described, and experience has narrowed these down to the suprapubic transvesical operation (Freyer) or retropubic prostatectomy (Millin) [2,3]. Our main goal was to show the feasibility of the laparoscopic technique and the short training period for teams already familiar with laparoscopy. This technique is similar to that of Millin at the anatomical level. ADVANTAGES AND DISADVANTAGESDespite prolonged and worldwide practice, suprapubic transvesical or prevesical approaches still present significant morbidity rates (6-10%) and blood loss, both during and after surgery [3,7]. The operation is often lengthy, with a relatively high incidence of postoperative wound infection and secondary haemorrhage [8]. Retropubic prostatectomy remains a useful procedure, with minor bleeding in the prostatic fossa and relative freedom from infection in the bladder [8]. Moreover, the postoperative course for the INDICATIONSBPH affects ª 70% of men aged > 70 years and is a significant cause of morbidity for those with BPH of > 60 g [1,2]. It has traditionally been treated by suprapubic trans-or extravesical prostatectomy [3,4]. Despite improvements in perioperative care, the complication rate remains significant. Severe bleeding occurred in 11.6% of patients analysed in a recent multicentre retrospective study [5], with a transfusion rate of 8.2%; sepsis in 8.6% and a median hospitalization of 7 ...

Laparoscopic versus Open Simple Prostatectomy: An Evaluation of Morbidity

“…2,[7][8][9][10][11][12] While LSP was originally described using an intraperitoneal approach, 2 the procedure was performed in the extraperitoneal environment in several studies. 1,3,7,9,10 Here, This compared with the series by Baumert and associates 1 in which duration of catheterization and hospital stay were significantly less as well. Average length of catheter duration postoperatively in the literature ranges between 3 days and 6.3 days.…”

Robot‐assisted simple prostatectomy (RASP): does it make sense?

“…Firstly, many authors report a reduction in the operative duration as the number of procedures performed increases, showing an inverse relationship between operative duration and surgeon experience, probably refl ecting an improvement in laparoscopic skills ( Table 4 ) [ 9, 18,19,25,28,29,33 ] .…”

“…Many authors emphasise the role of the incidence view due to the position of the optic system allowing a better ' vascular control [ due to ] improved visualization ' [ 23 ] and also a ' direct visual monitoring which enabled selective coagulation and an excellent joining of the capsule ' [ 25 ] .…”

“…Considering the surgeons viewpoint, the laparoscopic approach allows better vision due to image magnifi cation and an almost [ 25 ] 125 → 55 ' 0 ' Sotelo et al [ 9 ] 380 → 85 25.2% (intermittent) Baumert et al [ 18 ] 0.33 + 0.7 Porpiglia et al [ 28 ] 128 → 86.5 385 vs 430 mg Mariano et al [ 29 ] 1.5 days Massoud et al [ 33 ] 0 McCullough et al [ 19 ] 2.4 + 1.6 OSP median 4.0 bloodless fi eld due to the pneumoperitoneum. However, the fl at (two-dimensional) vision, with only three-degrees of freedom for instrument movement and prolonged standing and uncomfortable operating position are important disadvantages determining long learning curves and afterwards, slow refi nement of laparoscopic skills.…”

Early Experience with Laparoscopic Retropubic Simple Prostatectomy in Patients with Voluminous Benign Prostatic Hyperplasia (BPH)

“…Laparoscopic simple prostatectomy causes less intraoperative bleeding than does open simple prostatectomy, thanks in part to the wide eyeshot and high-pressure CO 2 [19]. In addition, it has the merits of minor surgical scars, shorter hospital stay, less analgesic utilization, and more rapid return to physical activities [9].…”