Single-Port Extraperitoneal Transvesical Adenomectomy: Initial Operative Experience

Abstract

Background: Laparoscopic extraperitoneal adenomectomy is occasionally performed for symptomatic large-volume benign prostatic hyperplasia. Two different multichannel ports were used during operations. We describe the technique of single-port extraperitoneal transvesical adenomectomy and present the initial operative experience. Methods: Three patients in whom an open adenomectomy was indicated underwent single-port extraperitoneal transvesical adenomectomy. Following preparation of the extraperitoneal space via an umbilical incision, a multichannel port was inserted. A transverse cystotomy adjacent to the prostatovesical junction, incision of mucosa overlying the adenoma, subcapsular plane development, prostatic adenomectomy and cystotomy repair were performed as the standard steps of the laparoscopic procedure. Results: All cases were completed without conversion to standard laparoscopy. Mean operative time was 105 min. Mean blood loss was 190 ml. Hospital stay was 4 days and catheter duration was 6 days for all patients. No intraoperative or postoperative complication occurred. Conclusions: Single-port extraperitoneal transvesical adenomectomy for large benign prostate hyperplasia is feasible with excellent cosmetic results and minimal morbidity.

Endoscopic simple prostatectomy

“…To avoid the basic limitations of LESS, collision of the robot's arms and small operative space, single–site instruments designed for the da Vinci ® Surgical System were used to perform single port transvesical enucleation of the prostate (STEP) [ 36 , 37 ]. In recent years, several clinical studies and case reports have been published on LESS [ 35 , 37 – 42 ]. Preliminary functional outcomes are encouraging, but the procedure is associated with a high risk of complications, and its role has yet to be determined [ 37 ].…”

Resultados de la prostatectomía retropúbica abierta y adenomectomía prostática laparoscópica en 38 casos de hiperplasia prostática benigna tratados en el Hospital General del Estado de Sonora

“…La hiperplasia prostática benigna (HPB) es una de las principales causas de retención urinaria y es la causa más común de sintomatología del tracto urinario inferior en alrededor del 60% de los hombres de 60 años de edad o mayores 1 . Aproximadamente 3 de cada 10 pacientes son candidatos a tratamiento quirúrgico 2 .…”

Laparoscopic Simple Prostatectomy

“…Hoepffner et al, in their study with the biggest series published, reported 100 patients' results with mean prostate weight of 97.1 ± 18.5 g, mean operation time 66.3 ± 12.3 min with blood loss of 250 ± 86.8 ml without the need of blood transfusion with mean hospital stay of 4.2 ± 1.3 days and mean catheterization time of 3.2 ± 1 days[38]. Oktay et al reported the results of 16 LSP patients with the biggest prostate weight, 147 g (between 80 and 200 g), mean operation time 133 min (75-210 min), mean blood loss 134 ml (50-300 ml) requiring one transfusion, hospital stay 3.9 days (2-7 days), and catheterization duration of 6.3 (6-7) days[39].Chlosta et al., in their series of 66 patients, reported surgery time of 55 (45-85) minutes as the shortest surgery time and similar results for blood loss, hospital stay, and catheterization time[40].…”