Extraperitoneoscopic Transcapsular Adenomectomy: Complications and Functional Results After at Least 1 Year of Followup

Abstract

Results suggest that laparoscopic simple prostatectomy is safe and effective even after a significant period, as indicated by the low complication rate and positive, stable functional results found during followup. In our opinion laparoscopic simple prostatectomy can be offered to patients as a valid treatment option for a large prostate at advanced laparoscopic centers.

Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European–American Multi-institutional Analysis

“…The dissection of the adenoma can be facilitated by finger assistance, placement of a retraction suture on the adenoma, or use of specific instruments (ie, the robotic tenaculum). Hemostasis in laparoscopic cases has been achieved with selective suturing of bleeders in the prostatic resection bed [18,19,21]. With the adoption of robot-assisted surgery, more complex suturing tasks have been explored, such as plication of the prostatic capsule or vesicourethral anastomosis [23,28].…”

“…Study coordinators were the first and senior authors of this report. Each investigator adopted specific intraoperative strategies and technical nuances to optimize the procedure [10,[18][19][20][21][22].…”

“…Surgical techniques in minimally invasive simple prostatectomy: an overview Transversal incision on the prostate capsule; adenoma dissected with scissors or Maryland forceps[21] Adenoma enucleation by finger assistance[18,19] Laparoscopic transvesical Transverse cystostomy; adenoma dissection with J hook cautery and suction-irrigation cannula[22] Transverse cystostomy; adenoma dissection with harmonic scalpel and suction-irrigation cannula[20] Robotic transcapsular Transverse capsular incision approximately 1-2.5 cm from the vesicoprostatic junction[24,29] Robotic transvesicalHorizontal cystotomy proximal to the vesicoprostatic junction; stitches placed in the lateral lobes to create traction during the adenoma dissection[12,26,29] Ligation of DVC; incision of the anterior bladder neck just proximal to the vesicoprostatic junction; adenoma dissection started posteriorly; plication of the posterior prostatic capsule, continuous vesicourethral anastomosis, anterior prostatic capsule sutured to the anterior bladder wall[23] Transverse cystotomy at the bladder neck; traction suture placed on the adenoma; use of a robotic tenaculum grasper[25] Bladder dome identified and midline cystotomy made; stay sutures to keep the edges of the cystotomy open; traction suture through the adenoma to aid dissection [27] Intrafascial procedure: early release of neurovascular bundles; DVC suture ligated; horizontal cystotomy incision at the bladder neck; seminal vesicles transected at the prostate base, vesicourethral anastomosis [28] DVC = dorsal vein complex. and the median hemoglobin level drop on postoperative day 1 was 2 (range: 1-3.2) mg/dl.…”

Adenomectomía laparoscópica extraperitoneal «sin nudos»

“…Independientemente de la modalidad de AL, este procedimiento es altamente efectivo a largo plazo en el tratamiento de la HBP de gran tamaño y combina los beneficios de los procedimientos mínimamente invasivos con los resultados favorables de la cirugía abierta 23,42 . Por ello puede ofrecerse a los pacientes como una opción válida para tratar grandes adenomas en centros de avanzada experiencia en laparoscopia.…”

Laparoscopic Simple Prostatectomy

“…Porpiglia ve ark. 'nın laparoskopik basit prostatektomi yapılan 78 hastanın en az bir yıllık takip sonuçlarını değerlendirdikleri çalışmada üroflovmetri, maksimum akış hızı ve İPSS quality life index skorlamasında postoperatif sonuçların preoperatif sonuçlara göre anlamlı daha iyi olduğunu rapor edilmiştir (14). Bu çalışmada laparoskopik basit prostatektominin uzun dönemde de güvenli, düşük komplikasyon oranlarına sahip, kalıcı fonksiyonel sonuçları olan bir cerrahi yöntem olduğu sonucuna varılmıştır.…”