Laparoscopic adenomectomy in the treatment of benign prostatic hyperplasia
Article published in Urologia Polska 2008/61/1.

authors

Marcin Słojewski, Adam Gołąb, Marcin Gałęski, Andrzej Sikorski: Katedra i Klinika Urologii Pomorskiej Akademii Medycznej w Szczecinie

keywords

prostate, prostatic adenoma, surgical treatment, prostatectomy, laparoscopy

summary

Introduction. Recently reports about laparoscopic prostatectomy (LP) has been published Millin’s transcapsular technique or transvesical approach is used by particular authors. In this paper we present our experience with LA. We also describe in details our surgical

technique.

Material and methods. Between 12.2006 and 10.2007 we have performed10 LAs in men from 59 to 78 years old. Prostate volume, evaluated with transrectal ultrasonography was between 110 and 190 ccm. All procedures were performed under general anaesthesia with extraperitoneal approach. In three cases transvesical technique was applied, and in seven cases Millin’s method was used with “finger assisted” removal of adenoma in six of them.

Results. Among ten operations there were two cases of conversion to open procedure. There were no serious intraoperative complications. Average “skin to skin” operative time was 82 minutes. The weight of removed adenoma was approximately 98 g. The mean blood loss was evaluated on 280 ml. Hospital stay was from 3 to 7 days (aver. 4,1).

Conclusions. LA is a feasible technique. In our opinion extraperitoneal approach is more suitable and allows the classic approach in case of conversion. Our preliminary results suggest the possibility to introduce this method in the future as a routine in centers with laparoscopic skills. Shorter hospitalization and low complication rate are additional advantages. This minimally invasive technique is a reasonable alternative to open simple prostatectomy.

references

Serretta V, Morgia G, Fondacaro L et al: Management of symptomatic benign prostatic hyperplasia in southern Italy: a retrospective analysis of the Sicilian-Calabrian Society of Urology (SSCU) of 32,000 patients. Urol Int 2003, 71, 16-21.
Torrelles GM, Lloret CV, Armada JR et al: Results of the surgical treatment of benign prostatic hyperplasia in geriatric patients. Arch Esp Urol 2007, 60, 23-30.
Pilpel D, Porath A, Pelega A: Quantitative evaluation of prostatectomy for benign prostatic hypertrophy under a national health insurance law: a multi-centre study. J Eval Clin Pract 2002, 8, 9-18.
Sotelo R, Spaliviero M, Garcia-Segui A et al: Laparoscopic retropubic simple prostatectomy. J Urol 2005, 173, 757-760.
Mariano MB, Graziottin TM, Tefilli MV: Laparoscopic prostatectomy with vascular control for benign prostatic hyperplasia. J Urol 2002, 167, 2528-2529.
Mariano MB, Tefilli MV, Graziottin TM et al: Laparoscopic prostatectomy for benign prostatic hyperplasia-a six-year experience. Eur Urol 2006, 49, 127-131.
van Velthoven R, Peltier A, Laguna MP, Piechaud Th: Laparoscopic extraperitoneal adenomectomy (Millin): pilot study on feasibility. Eur Urol 2004, 45, 103-109.
Bollens R, Bossche M, Roumeguere T et al: Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol 2001, 40, 65-69.
Porpiglia F, Terrone C, Renard J et al: Transcapsular adenomectomy (Millin): a comparative study, extraperitoneal laparoscopy versus open surgery. Eur Urol 2006, 49, 120-126.
Baumert H, Ballaro A, Dugardin F, Kaisary A: Laparoscopic versus open simple prostatectomy: a comparative study. J Urol 2006, 175, 1691-1694.
Słojewski M, Gołąb A, Petrasz P i in: Adenomektomia laparoskopowa – pierwsze doświadczenia dotyczące metody. Urol Pol 2007, Suppl 1, 53-54.
Słojewski M, Petrasz P, Gołąb A et al: ‘Finger-assisted’ laparoscopic adenomectomy – a feasible method of removal of large prostatic adenomas. Eur Urol Meet 2007, 2, 22.

correspondence