Abstract

LAPAROSCOPIC EXTRAPERITONEAL ADENOMECTOMY:
Comparative study with open technique

Alejandro García-Segui, Eduardo Bercowsky, Ignacio Gómez, Ramon Gibernau, Miguel Gascón
Hospital General Mateu Orfila. Department of Urology. Menorca- Spain

INTRODUCTION AND OBJECTIVE: Despite the development of minimally invasive techniques, open adenomectomy is frequently performed in many countries for large adenomas. Laparoscopic and robotic adenomectomy have been reported previusly. We present our experience with Laparoscopic Extraperitoneal Adenomectomy (LEA) and prospectively compared with open technique.
METHODS: 39 men with symptomatic BPH (prostate volume > 80 cc) were included. The first 11 consecutive cases underwent LEA. Subsequent cases were included in the comparative study. Fifteen patients underwent LEA and thirteen patients were treated by open Millin`technique.The steps of extraperitoneal 4–port technique include inverted T incision just proximal to the prostato-vesical junction, development of the subcapsular plane, enucleation, urethral transection, trigonization to prostatic fossa or posterior urethral stump, and suture-repair of the prostatic capsule.
RESULTS: There was no significant difference in age, prostate size, uroflow rate (Qmax), mean International Prostate Symptom Score(IPSS), and quality of life score(QoLs) between the two groups. Post-operative IPSS, QoLs ,Specimen weight and catheter time were similar. Mean operative time was longer in the laparoscopic group (135 range 90-210 vs. 113,23 range 70-150 minutes,P=0.07). Mean Estimated Blood Loss (228.6 range 100-500 vs 421.5 range 250-1000 mL,P=0.003), mean irrigation time (22.86 range 0-36 vs 31.38 range 24-48 hours,P=0.02), and average hospital stay (3.7 range 2-5 vs 4.8 range 3-8 days, P=0.04) were significantly less in the laparoscopic group. There were more incidence of hemorragic and related abdominal wall complications in the open group.

CONCLUSION: LEA is relative complex technique that requires skill in laparoscopy, but is a feasible and safe alternative to open prostatectomy. In LEA an excellent view achieved and allows a meticulous dissection between capsule and adenoma to get a haemostatic and careful technique with accurate urethral cut. LEA offers advantages in term of shorter irrigation, shorter hospital stay, lower blood loss, and complications rate; in addition to the known benefits of laparoscopy (limited pain, faster recovery, cosmetic, simultaneous treatment of concomitant surgical pathologies).