Laparoscopic Extraperitoneal Adenomectomy (Millin): Pilot Study on Feasibility

U-shape incision on prostate capsule: New intraperitoneal laparoscopic technique in simple prostatectomy: A case report

Introduction

and importance: Laparoscopy is a known technique for simple prostatectomy using intraperitoneal or extraperitoneal approaches. In the present study, a novel method is suggested for easier access to the whole body and even the head of the adenoma.

Case presentation

This method was performed on 6 patients with prostate hyperplasia. This was intraperitoneal method, started with 4–6 trocars and two transverse incisions on both sides of the endopelvic fascia. the prostate capsule is detected (using a Foley catheter balloon); the prostate capsule is transversely opened by a U-shape incision in a 0.5–1cm distance from the bladder neck to reach the adenoma and is dissected under the capsule to separate the capsule from the prostate. By ligashour capsule is opened laterally to the endopelvic fascia and separated from the prostate and gland is removed.

Clinical discussion

The mean operation time was 114 minutes and the average intraoperative bleeding was 244.1 cc. IPSS (International Prostate Symptom Score), Q Max, and post-void residue, changes were significant with p-value = 0.003, respectively; however, pre and postoperative Hemoglobin was imprecise. The mean postoperative urinary leakage is reported at 22 cc.

Conclusion

In short, this technique provides a better vision to prostate adenoma and the results can be compared with other laparoscopic approaches. Yet, larger sample sizes in different centers are required for determining realistic results.

•

The new U-shape intraperitoneal simple laparoscopic prostatectomy method is quite uncomplicated and accessible for all surgeons.

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A novel method is suggested for the head of the adenoma.

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This technique can be compared with other laparoscopic approaches.

From open simple to robotic-assisted simple prostatectomy (RASP) for large benign prostate hyperplasia: the time has come

PURPOSE

Robotic-assisted simple prostatectomy (RASP) has recently been studied as an alternative to open simple prostatectomy or endoscopic treatment options. At present, there is no defined recommendation for a robotic procedure as a standard surgical technique to treat large benign prostate hyperplasia.

METHODS

Several robotic techniques have been described since 2007. Contemporaneously, multiple endoscopic enucleation techniques have been proposed. Nevertheless, open simple prostatectomy still remains a mainstay of therapy. We aimed to evaluate the development of robotic-assisted prostatectomy for large benign prostatic obstruction, thus comparing the technical aspects and clinical outcomes with open and endoscopic enucleation.

RESULTS

Robotic-assisted simple prostatectomy provides significantly less blood loss and shorter hospital stay but longer operative time compared to open simple prostatectomy. Compared to endoscopic treatments, robotic approaches have a similar perioperative outcome, but cause less urethral trauma or potential bladder neck strictures. Moreover, concomitant bladder pathologies can be treated within the same setting.

CONCLUSION

Robotic-assisted simple prostatectomy is an effective and safe technique, and can hence be considered to become the preferred first-line therapy to treat patients with obstructive large prostate glands.

Endoscopic Transvesical Adenomectomy of the Prostate, a New Minimal Invasive Approach for Large Benign Prostate Hyperplasia. A Description of the Technique and the Results of the First 40 Patients

OBJECTIVE

The objective of this study is to present the results in the first 40 patients treated with a new minimal invasive technique in the treatment of large-volume benign prostate hyperplasia: the endoscopic transvesical adenomectomy of the prostate (ETAP).

PATIENTS AND METHODS

From 2014 to 2016 we performed the ETAP in 40 patients with large volume benign prostate hyperplasia (>80 cc). The mean volume on ultrasound was 117 cc. The mean baseline Qmax was 8.1 ml/s and the International Prostate Symptom Score was 20.5. Seventeen patients (43%) had a urinary retention preoperatively. A cystotomy through a small infraumbilical incision was performed and a camera port was placed through the bladder dome. A pneumovesicum was created and 2 instrument ports were placed into the bladder. The prostate was transected and removed in 1 piece through the umbilical incision.

RESULTS

The operation was completed in all 40 patients, without need for conversion. The mean operation time was 102 minutes with a mean blood loss of 185 ml. The average hospital stay was 5 days. There were no grade V complications and 1 grade IV complication. The transfusion rate was 2.5%. After the procedure, all 40 patients were able to void spontaneous. The Qmax increased to 21.2 ml/s (+13.1 ml/s) and the International Prostate Symptom Score decreased to 7.5 (-13 pts).

CONCLUSION

This study shows that the ETAP is a feasible, safe, and truly minimal invasive procedure. The functional outcomes are promising as well. We believe the ETAP is good alternative to open surgery.

Laparoscopic adenomectomy: 10 years of experience

INTRODUCTION

Lower urinary tract symptoms secondary to increased prostate volume are associated with ageing and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement.

MATERIALS AND METHODS

We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalisation.

RESULTS

We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21mL/s and 22.52mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4mL and 14.2mL, respectively. The mean surgical time was 137.7min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5.

CONCLUSION

Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications.

Laparoscopic adenomectomy in BPH - Does it have a role today?

Symptomatic benign prostatic hyperplasia (BPH) is managed medically worldwide, but transurethral resection of prostate (TURP) is the gold standard in refractory cases. Holmium laser enucleation of prostate (HoLEP), laser vaporization are other options which are widely practiced. However in larger glands which are more than 80 g, open adenomectomy is still practiced. Laparoscopic adenomectomy is a minimally invasive option in such circumstances. This article explains about different techniques in minimally invasive adenomectomy and the role for this procedure today. Laparoscopic simple prostatectomy (LSP) has a place in symptomatic, larger prostatic adenoma in the hands of experienced laparoscopic surgeons when open simple prostatectomy is needed.

Holmium Laser Enucleation of the Prostate versus Laparoscopic Transcapsular Prostatectomy: Perioperative Results and Three-Month Follow-Up

PURPOSE

Symptomatic benign prostatic hypertrophy greater than 70 cc used to be treated by invasive procedures. Holmium laser enucleation of prostate (HoLEP) and laparoscopic transcapsular prostatectomy (LTP) are two techniques whose efficacy has been demonstrated compared to standard onesmore invasive standard procedures. The objective was to evaluate and compare perioperative results from these two techniques for the treatment of benign prostatic hypertrophy greater than 70 cc.

METHODS

This was a non-randomized retrospective study comparing the HoLEP technique with LTP. From January 2012 to January 2015, 39 patients had HoLEP and 28 had LTP. Perioperative outcomes, complications, and functional results at 3 months were compared. A chi-2 squared test and Student's t test were used for statistical analysis.

RESULTS

In multivariate analysis, there was a statistically significant difference in favor of HoLEP for the duration of catheterization (1.9 vs. 3.7 days; p = 0.004) and the average length of stay (2.8 vs. 4.0 days, p = 0.010). There was a trend towards a greater decrease in postoperative hemoglobin levels in LTP (138 vs. 218 g/l; p = 0.082), which was statistically significant in univariate analysis (p = 0.033). Other endpoints were not significant, particularly the enucleated prostate volume compared to the total prostate volume (61.8 vs. 68.4%; p = 0.319) and postoperative complications.

CONCLUSION

There was no increased morbidity for LTP compared to the HoLEP technique. However, the HoLEP technique appeared to be a less invasive technique, reducing the duration of catheterization, blood loss, and the average length of stay while maintaining good efficacy for the enucleated prostate volume.

Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results

INTRODUCTION

Open adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques.

PATIENTS AND METHODS

The study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes>80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis.

RESULTS

The mean age was 69.2±7.7 years (range 42-87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78-260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (P<.0001) and catheter time (P<.0002) were longer in the LA group. Operative bleeding (P<.0001), transfusion rate (P=.0015) and mean stay (P<.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (P=.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (P=.13) or in the rate of late complications (at one year) (P=.66). There were also no differences between the groups in the functional postoperative results: IPSS (P=.17), QoL (P=.3) and Qmax (P=.17).

CONCLUSIONS

LA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times.

Open vs Laparoscopic Simple Prostatectomy: A Comparison of Initial Outcomes and Cost

INTRODUCTION

We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP).

PATIENTS AND METHODS

A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically.

RESULTS

No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different.

CONCLUSION

The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.

"Knotless" laparoscopic extraperitoneal adenomectomy

INTRODUCTION

Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation.

METHODS

A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision.

RESULTS

The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor.

CONCLUSIONS

"Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique.

Endoscopic simple prostatectomy

INTRODUCTION

Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH.

MATERIAL AND METHODS

We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH.

RESULTS

Laparoscopic adenomectomy (LA) and robotic-assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work.

CONCLUSIONS

Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH.

Outcomes of minimally invasive simple prostatectomy for benign prostatic hyperplasia: a systematic review and meta-analysis

PURPOSE

(1) To assess the outcomes of minimally invasive simple prostatectomy (MISP) for the treatment of symptomatic benign prostatic hyperplasia in men with large prostates and (2) to compare them with open simple prostatectomy (OSP).

METHODS

A systematic review of outcomes of MISP for benign prostatic hyperplasia with meta-analysis was conducted. The article selection process was conducted according to the PRISMA guidelines.

RESULTS

Twenty-seven observational studies with 764 patients were analyzed. The mean prostate volume was 113.5 ml (95 % CI 106-121). The mean increase in Qmax was 14.3 ml/s (95 % CI 13.1-15.6), and the mean improvement in IPSS was 17.2 (95 % CI 15.2-19.2). Mean duration of operation was 141 min (95 % CI 124-159), and the mean intraoperative blood loss was 284 ml (95 % CI 243-325). One hundred and four patients (13.6 %) developed a surgical complication. In comparative studies, length of hospital stay (WMD -1.6 days, p = 0.02), length of catheter use (WMD -1.3 days, p = 0.04) and estimated blood loss (WMD -187 ml, p = 0.015) were significantly lower in the MISP group, while the duration of operation was longer than in OSP (WMD 37.8 min, p < 0.0001). There were no differences in improvements in Qmax, IPSS and perioperative complications between both procedures. The small study sizes, publication bias, lack of systematic complication reporting and short follow-up are limitations.

CONCLUSIONS

MISP seems an effective and safe treatment option. It provides similar improvements in Qmax and IPSS as OSP. Despite taking longer, it results in less blood loss and shorter hospital stay. Prospective randomized studies comparing OSP, MISP and laser enucleation are needed to define the standard surgical treatment for large prostates.

Benefits of laparoscopic prostate-sparing radical cystectomy

PURPOSE

Prostate-sparing radical cystectomy has been described in the literature and has proven to be a promising procedure owing to the continence and erectile function results without necessarily compromising the oncologic outcome in selected patients.

TECHNIQUE POINTS

A transperitoneal approach is used. Lymph node dissection is performed with frozen section, and then the ureters are ligated and biopsied. The seminal vesicles are dissected, followed by complete mobilization of the bladder. Incision of the bladder neck is performed, followed by simple prostatectomy. Finally, bowel reconstruction is carried out via a small infra-umbilical incision that also permits the extraction of the surgical specimen and the anastomosis of neobladder to the prostate capsule. A total of 25 patients have undergone this procedure, with average surgical times of 285 min and blood loss of 640 ml. The complications encountered included: one bowel incarceration, one urinary leak, one lymphocele and one port hernia. At median 9 months follow-up, no patient presented with daytime incontinence, although seven complained of nocturia. A total of 20 patients maintained their preoperative sexual potency, and four reported a postoperative decrease in their erectile function.

CONCLUSIONS

Laparoscopic prostate-sparing radical cystectomy appears to be oncologically safe, reproducible and has promising functional benefits. The authors believe this procedure presents a good option in very select patients.

[Endoscopic prostate resection by bipolar gyrus resector for prostates over 80 ml: our experience after a 12-month follow-up]

INTRODUCTION

The open surgery approach is the gold standard for the treatment of prostatic adenoma with a volume over 80 mL.

PATIENTS AND METHODS

We studied 180 patients from June 2004 to June 2011, affected by prostatic adenoma >80 mL, and who underwent endoscopic resection performed with bipolar technique by a single operator. We considered the following data: surgery duration, bleeding, absorption of irrigating fluids, resected tissue quantity, clinical stay, and catheterization time. Resections up to the surgical capsule were performed with bipolar Gyrus resector and the fragments were collected with prostate Ellik-type conveyor. Next step was the positioning of the bladder catheter with cystoclysis. We evaluated early and late complications and performed clinical reassessment of the patients at 1, 3, 6 and 12 months.

RESULTS

Surgery average time was 118 min. The average resected tissue volume was 92 g. The post-surgery hemoglobin was 13.2 g/dL. In 15 patients a revision of the lodge was performed within 24 hours after resection; no blood transfusions were performed. The catheter was removed after 3.2 days and the average recovery time was 4 days. There were eight cases of cicatricial stenosis of the bladder neck treated with endoscopic laparotomy. There were no cases of post-TURP syndrome. The IPSS parameters varied from 20.7 to 3.8, the IIEF5 from 19.3 to 21.2. The average QoL decreased from 4 to 1.5, Qmax from 22.2 7.7 mL/sec. The total PSA values decreased from 6.39 ng/mL to 1.0 ng/mL.

CONCLUSIONS

TURP for prostatic adenomas greater than 80 mL in volume, is a valid alternative in terms of efficacy and safety to open surgery, considered the gold standard treatment.

Preperitoneal single-port transvesical enucleation of the prostate (STEP) for large-volume BPH: one-year follow-up of Qmax, IPSS, and QoL

OBJECTIVE

To evaluate the 1-year efficacy and safety of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH).

METHODS

Nine patients with moderate- to large-volume (83.8 ± 19.9 mL) BPH (mean age 71.9 ± 6.39 years, body mass index [BMI] 21.5 ± 3.25 kg/m(2)) were preoperatively evaluated by abdominal and transrectal ultrasonography, uroflowmetry, International Prostate Symptom Score (IPSS) and Quality of Life Index (QoL). The STEP procedures were performed by a single surgeon. All patients were followed up for a minimum of 12 months postoperatively by ultrasonography, uroflowmetry, IPSS, and QoL.

RESULTS

STEP was smoothly completed in 8 cases with 1 case of open conversion owing to failure of the single-port device insertion. The mean operative duration was 160.9 ± 30.24 minutes, and the estimated blood loss was 418.8 ± 282.76 mL. One intraoperative complication of bleeding occurred. Postoperative complications occurred for 2 patients, including one case each of acute epididymitis and urethral stricture. At the 12-month follow-up after surgery, the mean Q(max) of the entire cohort was 22.7 ± 4.62 mL/s (an increase of 12.9 mL/s), with an average postvoid residual volume of 36.1 ± 40.02 mL, an IPSS of 4.1 ± 1.36 (a decrease of 21 points), and a QoL of 1.4 ± 1.19 (a decrease of 3.2 points). No patients developed incontinence or bladder neck contracture.

CONCLUSION

In selected patients with voluminous BPH, STEP is a safe, feasible, and efficacious procedure with a promising outcome at 1-year follow-up in terms of Q(max), IPSS, and QoL.

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

Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The open simple prostatectomy (OSP) is the 'gold standard' for high-volume prostate adenomas. It shows very good functional results despite its invasiveness. Minimally invasive approaches, e.g. laparoscopy or holmium laser enucleation of the prostate, have been 'tested' but none have proved a substitute for the OSP. The robot-assisted approach provides optimal functional results and is easy to perform for experienced robotic surgeons. Extending the indication of robotics to low-incidence pathologies can take advantage of the opportunity to 'see the procedure' using available information technology, e.g. Youtube™ that presents as an unexpectedly useful tool.

OBJECTIVE

• To evaluate the outcome, feasibility and reproducibility of a robot-assisted (RA) approach for simple prostatectomy (SP) in cases of high-volume symptomatic benign prostatic hyperplasia (HVS-BPH).

PATIENTS AND METHODS

• In all, 35 consecutive patients underwent RASP for HVS-BPH using a previously described technique. • The mean prostate volume on preoperative transrectal ultrasonography was 106.6 mL. • All but two patients (with bladder calculi) had an adenoma volume of >65 mL and 27 (77.1%) >80 mL. Nine patients (25.7%) had an indwelling catheter. • The mean International Prostate Symptom Score (IPSS) was 28.

RESULTS

• The median operative duration was 180 min and the mean hospital stay was 3.17 days. • The mean catheter duration was 7.4 days and discontinuous or continuous catheter irrigation was required in two and seven patients, respectively (25.1%). • In all, 10 patients (28.6%) had practically no blood loss. No patients had a transfusion. • The mean postoperative peak urinary flow was 18.9 mL/s (P < 0.001), while the mean IPSS was 7 (P < 0.001). • For costs, while superficially RASP appeared more expensive than open SP (OSP), when considering the higher costs of hospitalisation for OSP, RASP was cheaper. Also, bipolar-TURP costs in patients with large-volume prostates had rather similar costs to RASP.

CONCLUSIONS

• RASP is a feasible and reproducible procedure with outcome advantages when compared with the open or with other minimally invasive techniques (laser or laparoscopy). As a result, a RA approach is worth considering in cases of high-volume prostate adenomas. • Extending the indication of the RA approach, to the SP, requires firstly that the surgeon be proficient in RA surgery and secondly that as the incidence rate of HVS-BPH is low, the surgeon has had the opportunity to 'see the procedure'.

The surgical treatment of a large prostatic adenoma: the laparoscopic approach--a systematic review

PURPOSE

To present a critical overview of the current literature on the role of laparoscopy for the surgical treatment of patients with large prostatic adenomas.

MATERIALS AND METHODS

A MedLine search for peer-reviewed studies on laparoscopic simple prostatectomy (LSP) was performed. The clinical studies that reported most of the following information were included: number of patients, prostate volume, operative time, blood loss, hospital stay, and the duration of catheterization, as well as functional outcomes and complications. Articles reporting a mean total prostate volume of <80 mL or a mean prostatic adenoma of <60 mL were excluded. The review was performed according to the PRISMA statement.

RESULTS

Fourteen articles on LSP were included in this systematic review with a total of 626 patients treated. Both transperitoneal and extraperitoneal approaches, as well as transvesical and transcapsular routes, have been described. Eleven articles were case-series and three were comparative retrospective nonrandomized studies. When compared with open simple prostatectomy (OP), LSP is associated with a less blood loss and a reduced irrigation requirement, a shorter postoperative catheterization period, and a shorter hospital stay, at the expense of an extended operative time. The limited number of patients treated, the selection biases due to the retrospective nature of several published articles on LSP, and the short follow-up periods are evident limits of the literature. I-square test demonstrated a high heterogeneity (93%) and consequently a high variability in the intervention effects in terms of maximum urinary flow rate (Qmax).

CONCLUSIONS

Even if LSP seems feasible and safe, there is still limited evidence regarding its long-term outcomes compared with OP.

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia

OBJECTIVE

Laparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy.

MATERIALS AND METHODS

From January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded.

RESULTS

The mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Qmax) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period.

CONCLUSIONS

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade ejaculation preserved.

[Comparative study between laparoscopic extraperitoneal and open adenomectomy]

OBJECTIVES

In spite of the development of endoscopic techniques, open adenomectomy continues to be the treatment of choice for large adenomas. Laparoscopic and robotic adenomectomy provides good results in specialized centers. The experience acquired with laparoscopic extraperitoneal adenomectomy (LEA) in a regional center is presented to evaluate its results and compare them prospectively with the results of open surgery.

PATIENTS AND METHODS

46 patients with benign prostatic hyperplasia (BPH) (prostate >80 g) and an indication for surgery were evaluated. The first 11 patients underwent LEA and were not included in the comparison. Thereafter, the cases were compared; 17 patients underwent LEA and 18, open surgery. In the extraperitoneal technique with 4 trocars, enucleation was performed with an ultrasonic scalpel.

RESULTS

There were no significant differences between groups in age, prostate volume, uroflow (Qmax), International Prostate Symptom Score (IPSS), Quality of Life scale (QoLs). The operation time was significantly greater in the LEA group (135.2 vs. 101.2 minutes, p = 0.022). Intraoperative bleeding (250 vs. 493.3 ml, p = 0.004), irrigation time (22.2 vs. 39.1 hours, p = 0.038), catheter indwelling time (5.5 vs. 7.5 days, p = 0.030), hospital stay (3.7 vs. 6.6 days, p = 0.006) and transfusion rate (0 vs. 22.2%) were significantly less in the laparoscopy group. There was a greater incidence of hemorrhagic and surgical wound complications in the open surgery group.

CONCLUSIONS

LEA is a relatively complex technique that requires laparoscopic skills, but it is a feasible and safe alternative to open surgery and has several advantages.

[Comparative study between laparoscopic extraperitoneal and open adenomectomy]

OBJECTIVES

In spite of the development of endoscopic techniques, open adenomectomy continues to be the treatment of choice for large adenomas. Laparoscopic and robotic adenomectomy provides good results in specialized centers. The experience acquired with laparoscopic extraperitoneal adenomectomy (LEA) in a regional center is presented to evaluate its results and compare them prospectively with the results of open surgery.

PATIENTS AND METHODS

46 patients with benign prostatic hyperplasia (BPH) (prostate >80 g) and an indication for surgery were evaluated. The first 11 patients underwent LEA and were not included in the comparison. Thereafter, the cases were compared; 17 patients underwent LEA and 18, open surgery. In the extraperitoneal technique with 4 trocars, enucleation was performed with an ultrasonic scalpel.

RESULTS

There were no significant differences between groups in age, prostate volume, uroflow (Qmax), International Prostate Symptom Score (IPSS), Quality of Life scale (QoLs). The operation time was significantly greater in the LEA group (135.2 vs. 101.2 minutes, p = 0.022). Intraoperative bleeding (250 vs. 493.3 ml, p = 0.004), irrigation time (22.2 vs. 39.1 hours, p = 0.038), catheter indwelling time (5.5 vs. 7.5 days, p = 0.030), hospital stay (3.7 vs. 6.6 days, p = 0.006) and transfusion rate (0 vs. 22.2%) were significantly less in the laparoscopy group. There was a greater incidence of hemorrhagic and surgical wound complications in the open surgery group.

CONCLUSIONS

LEA is a relatively complex technique that requires laparoscopic skills, but it is a feasible and safe alternative to open surgery and has several advantages.

[Laparoscopic simple prostatectomy (adenomectomy): experience in 59 consecutive patients]

OBJECTIVE

Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control.

MATERIALS AND METHODS

Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5 years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently.

RESULTS

All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123 minutes (90-180). The mean loss of blood was 415 ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively.

CONCLUSIONS

Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with.

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

Purpose

Laparoscopic simple prostatectomy was recently developed to treat voluminous benign prostatic hyperplasia (BPH). We describe the surgical technique and assess the feasibility of laparoscopic simple prostatectomy through our early experience.

Materials and Methods

The medical records of 11 patients who underwent laparoscopic simple prostatectomy between March 2008 and January 2010 were retrospectively analyzed. The subjects were limited to the patients who satisfied the following conditions: prostate volume was at least 75 g, acute urinary retention repeatedly occurred or maximal flow rate (Qmax) was at most 10 ml/s, and International Prostate Symptom Score (IPSS) was at least 12. The surgery was performed by the laparoscopic extraperitoneal approach with a transcapsular route. Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss) and perioperative complications. Data on short-term follow-up were also available.

Results

The mean age of the patients was 70.6 years. Mean preoperative prostate-specific antigen and prostate volume were 6.1 ng/ml and 109.3 cc, respectively. Mean operation time was 191.9 minutes and estimated blood loss was 390.9 cc. The resected adenoma weighed on average 72.4 g. No conversion to open surgery was required. Mean preoperative IPSS and quality of life (QoL) scores were 26.86 and 4.86. Mean Qmax, measured before the surgery, was 4.5 ml/s and residual urine was 106 ml. Mean postoperative IPSS and QoL scores were 4.2 and 1.5. After the surgery, mean Qmax was 15.5 ml/s and residual urine was 24.1 ml.

Conclusions

In the case of voluminous BPH, laparoscopic retropubic simple prostatectomy is expected to be a useful treatment on the condition that the learning curve can be overcome with clinical experience.

The accordion severity grading system of surgical complications

BACKGROUND

A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity grading system and to develop an improved system for reporting complications.

METHODS

129 articles were studied in detail. Twenty variables were searched for in each article with particular emphasis on type of study, substitution of qualitative terms for grades, grade compression, and cut-points if grade compression was used. We also determined relative distribution of complications and manner of presentation of complications.

RESULTS

T92 and derivative classifications have received wide use in surgical studies ranging from small studies with few complications to large studies of complex operations that describe many complications. There is a strong tendency to contract classifications and to substitute terms with self evident meaning for the numerical grades. Complications are presented in a large variety of tabular forms some of which are much easier to follow than others.

CONCLUSIONS

Current methods for reporting the severity of complications incompletely fulfill the needs of authors of surgical studies. A new system-the Accordion Severity Grading System-is presented. The Accordion system can be used more readily for small as well as large studies. It introduces standard definition of simple quantitative terms and presents a standard tabular reporting system. This system should bring the field closer to a common severity grading method for surgical complications.

A review of currently available vessel sealing systems

Laparoscopic surgery is rapidly expanding among urologists as a minimally invasive treatment with surgical procedures becoming increasingly challenging. Accurate haemostatis is of utmost importance in laparoscopy, as bleeding can rapidly impair the working environment conditions. We subsequently reviewed the different haemostatic tools used in laparoscopy with the focus on ultrasonic dissectors and electrothermal bipolar vessel sealer (EBVS). Briefly, there is a wide variety of haemostatic tools currently available in laparoscopy, all with their inherent advantages and limitations. The comparison of ultrasonic dissectors and EBVS shows that both systems are very attractive with similar physical properties concerning thermal spread and bursting pressure of vessels sealed. It has to be noted, however, that EBVS can handle vessels of up to 7 mm. In conclusion, haemostatic tools constitute a rapidly evolving domain with devices being developed which cause less thermal spread, while being more precise and faster. This evolution should finally allow more complex laparoscopic surgical procedures.

Laparoscopic versus open simple prostatectomy: an evaluation of morbidity

PURPOSE

To evaluate the morbidity between laparoscopic simple prostatectomy (LSP) and open simple prostatectomy (OSP) in the management of benign prostatic hyperplasia.

PATIENTS AND METHODS

From January 2003 through January 2008, 280 consecutive patients underwent adenomectomy either by an extraperitoneal laparoscopic transcapsular "Millin" approach (96 patients, 34.3%) or open transvesical approach (184 patients, 65.7%). Medical therapy had failed in all patients. Perioperative and outcome data were recorded and compared.

RESULTS

There was no significant difference in patient age, prostate size, uroflow rate, mean International Prostate Symptom Score, operative blood loss, or total time of continuous bladder irrigation between the two groups. Mean operative time was significantly longer in the laparoscopy group, 95.1 +/- 32.9 minutes, v the open group at 54.7 +/- 19.7 minutes (P < 0.0001). Total catheter time was significantly shorter in the laparoscopy group (5.2 +/- 2.6 v 6.4 +/- 2.9 days; P < 0.001) as was length of hospital stay (6.3 +/- 1.9 v 7.7 +/- 2.4 days; P < 0.0001). The most common complication between the two groups was hemorrhage, occurring in 27 (28.1%) patients in the laparoscopy group and 54 patients (29.3%) in the open group. Of the 19 urinary tract infections observed between the two groups, 18 occurred in the open group as well as all 9 cases of urinary sepsis.

CONCLUSIONS

LSP offers advantages over OSP in terms of shorter catheter time, shorter hospital length of stay, and fewer urinary tract infections.

Open adenomectomy: past, present and future

PURPOSE OF REVIEW

Open surgery has been the gold standard for the treatment of benign, symptomatic, large volume prostatic hyperplasia. Recent data series, however, have demonstrated that a minimally invasive approach can be used for the treatment of this pathology while duplicating the results of the open technique. This review will describe the different surgical techniques that have been used through the last century for the treatment of benign prostatic hyperplasia, highlighting the advantages and disadvantages of each approach.

RECENT FINDINGS

Surgical management for symptomatic benign prostatic hyperplasia has made a journey from an open approach to robotic surgery. Modifications of the gold standard transurethral resection have been incorporated into clinical practice and include bipolar transurethral resection as well as holmium laser resection and potassium titanyl phosphate laser vaporization. Minimally invasive ablative techniques have also been popularized and include transurethral needle ablation and thermotherapy. Most recently, laparoscopy has demonstrated to be a feasible, safe, reproducible technique that can create similar outcomes to an open technique whilst maintaining the advantages of a minimally invasive approach. Although the future will see greater use of robotics, larger series are needed to prove the advantages of this technology.

SUMMARY

Minimally invasive approaches for the treatment of symptomatic benign giant prostatic hyperplasia are replacing open surgery, which has been the gold standard for the surgical treatment of this pathology, duplicating its results with a lower morbidity. Recently we have seen a growing amount of experience treating this disease state with laparoscopic/robotics and the advantages it provides may permit the popularization of this technique.

Robotic simple prostatectomy

PURPOSE

Minimally invasive approaches for large, symptomatic benign prostatic hyperplasia are replacing the gold standard open surgical approach, duplicating its results with lower morbidity. We describe our initial experience with robotic simple prostatectomy.

MATERIALS AND METHODS

Since January 2007, robotic simple prostatectomy was performed via a transperitoneal approach in 7 patients with symptomatic significant prostatomegaly on transrectal ultrasound (mean 77.66 gm). Demographic, perioperative and outcome data were recorded and all procedures were performed by the same surgeon.

RESULTS

Average patient age was 63.2 years (range 56 to 72) and estimated blood loss was 298 ml (range 60 to 800). Average operative time was 205 minutes (range 120 to 300). Average hospital stay was 1.4 days (range 1 to 2), average Foley catheter duration was 7 days (range 6 to 9) and drains were removed after an average of 3.75 days (range 3 to 4). Mean specimen weight on pathological examination was 50.48 gm (range 40 to 64.5). Transfusion was necessary in 1 patient. No complications were documented. Considerable improvement from baseline was noted in International Prostate Symptom Score (preoperative vs postoperative 22 vs 7.25) and maximum urine flow (preoperative vs postoperative 17.75 vs 55.5 ml per minute). Four patients were in acute urinary retention preoperatively.

CONCLUSIONS

Robotic simple prostatectomy is a feasible, reproducible procedure. Further publications are expected with larger series and larger prostatic adenomas.

[The low hydraulic pressure transurethral resection of the prostate results in 340 patients with great adenomas]

INTRODUCTION

the transurethral resection of prostate TURP is the elective treatment for the small and medium adenomas. In this study they analyse the effectiveness, the results and the postoperative morbidity in the resection of the great adenomas.

PATIENTS AND METHOD

We study 340 patients with great adenomas and symptomatic infravesical obstruction that were operated with the low hydraulic pressure RTUP between August of 1999 and June of 2006.

RESULTS

Average Age of the patients 69 years (range 51-89). Prostate volume by TRUS, 107 ml (70-204). PSA 7,94 ng/ml (0,71-26,4). Weight of the resected fragments: 74,5gr. (50-160), time of the intervention 65 min. (35-155), postoperative urethral catheterisation 1.7 days (1-8), suprapubic derivation 6.5 days (5-15), the duration of hospital stay after surgery were 8 days (7-16), peak flow pre-op. 11.2 ml/sec. (5-15,7), post-operative 19.7 ml/sec. (7-41,3). There were no cases of TURP syndrome in this group. Operative complications: Urinary infection without fever (bacteria >100.000) 95 patients (27.9%), bladder derivation by preoperative urinary retention 53 patients (15,6%). 18 patients (5,3%) with postoperative urinary retention. 11 patients (3,2%), with infection and fever >38 degrees C. 7 patients (2%) with postoperative bladder bleeding, 2 patients (0,6%) with urethral lesion. 1 patient (0.3%), with massive scrotal hematoma (after vasectomy). Control of the pre and post operative hemoglobin: Hemoglobin pre-op 15 g/dl (12-19,3), hemoglobin post-op 11,5 g/dl (7,6-16,4), difference of (- 3,5g/dl) 23,3%. In only 29 patients (8.5%) it was necessary to carry out a sanguineous transfusions (heterolog) of 2 to 4 EC (500 ml), the TRUS was 125 ml, weight of the fragments 90 gr. (52-140), the hemoglobin pre-op was 14,72g/dl and post-op of 8,8g/dl with a difference of (- 5,92g/dl) 40.2%.

CONCLUSIONS

The video assisted low hydraulic pressure TURP, is an effective method in the surgical treatment of great prostate adenomas. The severe postoperative complications are little, and in 311 patients (91.5%) it was not necessary sanguineous transfusion. The stationary treatment and the urethral catheterisation is smaller in comparison with the open adenomectomy.

[Complications of laparoscopic urological procedures]

Laparoscopic urology has evolved considerably during last decade as well as number and spectrum of surgical related complications. Experiences reported by laparoscopic trained groups allow preventing, promptly recognizing, and safe and efficient management of the laparoscopic related complications. We present our complications in all patients undergoing urological laparoscopic procedures from November 1992 to June 2005. A literature search was conduced to evaluate complications of every laparoscopic procedure.

Laparoscopic versus open simple prostatectomy: a comparative study

PURPOSE

Laparoscopic simple prostatectomy has recently been developed to remove large prostatic adenomas causing bladder outflow obstruction. To our knowledge the advantages of the laparoscopic vs the standard open approach to this procedure remain undefined. We compared laparoscopic and open simple prostatectomy.

MATERIALS AND METHODS

Perioperative data on the first 30 consecutive laparoscopic simple prostatectomies performed by 1 surgeon were collected prospectively and compared with retrospectively collected data on a series of 30 consecutive open simple prostatectomies. A Millin and a transvesical-prostatic technique were used in the laparoscopic group and a transvesical technique was used in the open group.

RESULTS

There was no significant difference in prostatic size, patient age or body mass index between the 2 groups. In the laparoscopic group the mean International Prostate Symptom score +/- SD improved from 22.4 +/- 6.9 to 5.7 +/- 3.6 and the urinary flow rate improved from 8.1 +/- 2.5 to 24.6 +/- 12.1 ml per minute (each p <0.001). Mean total blood loss (367 +/- 363 vs 643 +/- 647 ml), irrigation time (0.33 +/- 0.7 vs 4 +/- 3.5 days), duration of catheterization (4 +/- 1.7 vs 6.8 +/- 4.7 days) and hospital stay (5.1 +/- 1.8 vs 8 +/- 4.8 days) were significantly less in the laparoscopic group than in the open group. Mean operative time was longer in the laparoscopic group (115 +/- 30 vs 54 +/- 19 minutes). Of the 30 patients in the laparoscopic group 24 did not require bladder irrigation. There was no apparent difference in the incidence or severity of complications. There was no difference in perioperative parameters or functional results between the 2 different laparoscopic techniques.

CONCLUSIONS

Laparoscopic simple prostatectomy has inherent advantages over the open technique. Further studies are indicated to determine whether this technique should be considered the treatment of choice for prostatic adenomas too large for safe endoscopic resection.

Transcapsular Adenomectomy(Millin): A Comparative Study, Extraperitoneal Laparoscopy versus Open Surgery

OBJECTIVE

To demonstrate the safety of the Millin extraperitoneal laparoscopic adenomectomy by comparing the laparoscopic and open approaches.

METHODS

From January 2003 to April 2005, patients, with indication of prostatic adenomectomy, were offered the chance to choose between 2 types of procedure: Millin adenomectomy with open or extraperitoneal laparoscopic approach. Forty patients were included in this prospective non-randomised study. The patients were divided into 2 Groups. Group A (20 patients) underwent extraperitoneal laparoscopic adenomectomy, while Group B (20 patients) was treated by open surgery. Pre-operative, peri-operative and post-operative parameters were evaluated. Group A was subdivided in two sub-groups (first ten and last ten) and peri-operative parameters were considered in order to determine the learning curve.

RESULTS

In terms of pre-operative parameters considered, the 2 study groups are comparable (p>0.3). As far as peri and post-operative parameters are concerned: mean blood loss for Group A was 411.6+/-419 ml, for Group B 687.5+/-298.6 ml (p=0.004). For all the other parameters no significant statistical differences were recorded (p>0.4). Mean operative time was 107.2+/-34.9 min in Group A, and 95.5+/-22.5 min in Group B. Mean adenoma weight in Group A was: 69,5+/-21.5 g, in Group B: 88.1+/-43.8 g. Mean haemoglobin levels in Group A was: 11.2+/-1.8 g/dl, Group B: 11.6+/-1.2 (10-13.4) g/dl. Mean Analgesic consuming (Tramadol) during the post-operative stay was 385+/-36 mg in Group A, versus 430+/-108 mg in Group B. Mean catheterization time was 6.3+/-3.7 days in Group A, 5.6+/-1.1 days in Group B. The mean hospital stay was 7.8+/-4.1 days in Group A, and 7+/-1.6 days in Group B. One patient (5%) from Group A was re-operated for bleeding and clot retention, whilst in Group B patients did not present complications which required any further intervention. As far as peri-operative and post-operative parameters of the two sub-Groups A (first ten patients and last ten patients) are concerned, the statistical evaluation shows a significant difference only on operative time (p=0.01). The p-value for the other parameters was not significant (p>0.1).

CONCLUSIONS

The extraperitoneal laparoscopic adenomectomy is a safe technique presenting results comparable to open surgery with the advantage of significantly lower peri-operative blood loss.

Laparoscopic Prostatectomy for Benign Prostatic Hyperplasia – A Six-Year Experience

PURPOSE

The Authors present their results using laparoscopic prostatectomy in the treatment of large benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Between March 1999 and March 2005, 60 patients were submitted to laparoscopic prostatectomy with vascular control for large BPH. The demographic, operative period and outcome data were recorded.

RESULTS

The average prostate weight was 144.50+/-41.74 gm. Mean operative time was 138.48+/-23.38 minutes and estimated blood loss of 330.98+/-149.52 ml. No patient required transfusions or conversion to open surgery. Post operative complications included one case of septicemia and three cases of prolonged ileum. The most frequent long-term complication was retrograde ejaculation, presented in all patients after 6 months of follow-up. The erectile function was preserved in all those patients who were potent before surgery. No urinary incontinence was reported by patients.

CONCLUSIONS

The results demonstrate that resection of large prostatic adenomas can be performed with a laparoscopic approach. The patients had a shorter hospital stay and early return to normal activity.

Extraperitoneal Laparoscopic Prostatectomy (Adenomectomy) for Obstructing Benign Prostatic Hyperplasia: Transvesical and Transcapsular (Millin) Techniques

PURPOSE

We describe extraperitoneal laparoscopic resection of large prostatic adenomas (<100 g) as an alternative to open simple prostatectomy by both the transcapsular or Millin and the transvesical approaches.

PATIENTS AND METHODS

We have performed more than 20 laparoscopic prostatectomies (adenomectomies) for benign prostatic hyperplasia (BPH) for glands >100 g. The initial two cases, with follow-up longer than 1 year, are included in this report. Using an extraperitoneal approach, enucleation of the obstructing prostatic lobes was performed with the aid of a Harmonic Scalpel and laparoscopic claw forceps. Hemostatic sutures were placed at 5 and 7 o'clock. The urethrovesical junction (transvesical) or capsulotomy (Millin) were closed in an interrupted fashion using intracorporeal sutures.

RESULTS

Both procedures were successful. The total operative time was 180 minutes for first the case and 120 minutes for the second. The adenoma removed was approximately 138 g in the first case and 102 g in the second case. The estimated blood loss was <50 mL and <200 mL, respectively. The postoperative courses were unremarkable. Analgesic requirements were minimal, and the patient was discharged on postoperative day 2 and 3, respectively. A follow-up examination at 1, 3, 6, and 12 months showed that the flow rate is >20 mL and the postvoiding residual volume 0, with normal continence and sexual potency in both men.

CONCLUSIONS

Extraperitoneal laparoscopic simple prostatectomy is a simple straightforward technique. Minimal bleeding, a reduced transfusion rate, shorter hospitalization, and faster recovery are additional advantages. This minimally invasive technique is a reasonable alternative to open simple prostatectomy for large glands with reduced morbidity.

LAPAROSCOPIC RETROPUBIC SIMPLE PROSTATECTOMY

PURPOSE

Open retropubic simple prostatectomy is occasionally performed for symptomatic, large volume benign prostatic hyperplasia. We describe the technique of laparoscopic simple retropubic prostatectomy.

MATERIALS AND METHODS

Since August 2001 at our 2 institutions laparoscopic simple retropubic prostatectomy has been performed in 17 patients with symptomatic significant prostatomegaly on transrectal ultrasonography (60 gm or greater, mean 93). Essential aspects of our 5 port technique are transverse cystotomy just proximal to the prostatovesical junction, subcapsular plane development, prostatic adenomectomy, prostatic fossa trigonization and prostatic capsule suture repair. Demographic, perioperative and outcome data were recorded.

RESULTS

Mean operative time was 156 minutes (range 85 to 380), blood loss was 516 ml (range 100 to 2,500), hospital stay was 48 hours (range 15 to 110), and Foley catheter duration was 6.3 days (range 3 to 7). Mean specimen weight on pathological examination was 72 gm (range 32 to 120). Five patients (29%) required blood transfusion. Complications occurred in 3 patients (19%), that is intraoperative hemorrhage, catheter clot obstruction and duodenal ulcer bleeding in 1 each. All patients reported complete continence during a followup period of 1 month to 2 years. Considerable improvement from baseline was noted in American Urological Association score (preoperative vs postoperative 24.5 vs 9.9) and the maximum urine flow rate (preoperative vs postoperative 7 vs 22.8 cc per minute).

CONCLUSIONS

Laparoscopic simple retropubic prostatectomy for large benign prostate hyperplasia is feasible. Our initial experience is presented.