Open adenomectomy: past, present and future

Abstract

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.

Robot-assisted laparoscopic prostatectomy for a giant prostate with retrieval of vesical stones

“…Mariano et al [12] first reported laparoscopic approach for simple prostatectomy (BPH), followed by Van Velthoven [13] and Sotelo [14]. However, the overall utility of robotic-assisted laparoscopic surgery for benign prostatic enlargements has been explored sparingly [10][11][12][13][14]. Recently, John et al [15] have shown in pilot study in their series of 13 patients with large benign adenomas that pre-peritoneal RAP is a feasible and reproducible procedure.…”

“…While the open enucleation technique of prostatectomy remains the gold standard [18] for massively enlarged prostate glands, nonetheless, we feel that in select patient(s) with a massive prostate, wherein enucleation or adenectomy is cumbersome, the technique of RAP with certain modifications may be used as a viable alternative. RAP may also facilitate simultaneous auxiliary procedures such as bladder stone(s) removal.…”

“…The surgical challenges and nuances associated with the robot-assisted laparoscopic management of giant prostate enlargement that need attention, as encountered with the present case include: (1) technically demanding extensive peri-prostatic dissection; (2) placing stay sutures on prostatic capsule to enable capsulotomy; (3) difficult enucleation due to the massive prostate enlargement leads us to perform (9) mild traction at the end of procedure helps in the prevention of subsequent oozing. In a recent review published by Noguera et al [18], the authors stated that while open surgery for benign, symptomatic, large volume prostates has been the gold standard, they also noted an emerging increase in the trend toward minimally invasive surgery (laparoscopic/robotics) for the treatment of symptomatic benign giant prostate glands with its attendant benefits that may permit a higher level of acceptance of such technique(s) in the near future. Some of the technical challenges associated with a pure laparoscopic surgical enucleation of giant prostate in select cases may be overcome by the use of robotic assistance.…”

“…Recently, robot-assisted laparoscopic retropubic prostatectomy has been reported [8][9][10], for an average size prostate too. A review by Noguera et al [11] stated that minimally invasive techniques (laparoscopic/robotics) are being used for management of symptomatic benign prostatic enlargements in an attempt to replace open surgery reproducing an identical outcome but with lower morbidity. Mariano et al [12] first reported laparoscopic approach for simple prostatectomy (BPH), followed by Van Velthoven [13] and Sotelo [14].…”

Single-Port Extraperitoneal Transvesical Adenomectomy: Initial Operative Experience

“…As the use of laparoscopic surgery continues to expand there have been centers performing laparoscopic simple prostatectomy [6][7][8][9][10][11][12][13] . Laparoscopic simple prostatectomy has the potential to combine the advantages of a minimally invasive technique with the favorable results of open surgery [15] . The evolution of urologic surgery involves an increasing progression towards a scarless technique.…”