Objective: The aim of the present work is to describe the surgical technique and to assess the feasibility of laparoscopic extraperitoneal adenomectomy in a pilot study.
Methods: Eighteen consecutive patients in whom an open adenomectomy was planned were operated on in a laparoscopic extraperitoneal fashion. In all patients indication was based on objective signs of obstruction. The laparoscopic approach was standard in all cases as follows: creation of a preperitoneal workspace, haemostatic control of lateral venous vesicoprostatic pedicles, transversal anterior incision of the prostate capsule, progressive enucleation of the adenoma with the help of an harmonic scalpel, suture of the posterior bladder neck to the prostate fossa, closure of the prostate capsule, and retrieval of the specimen. Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss and transfusion requirements) and per operative complications. Data on short term follow-up are also available.
Results: Mean age of the patients was 67.8 years (S.D. 6.2) and mean prostatic weight calculated by TRUS 95.1cm(3) (S.D. 28.1). Mean maximal flow (Q(max)) was 4.3ml/s (S.D. 3.4) with four patients (22.2%) presenting in retention. Mean duration of intervention was 145min (S.D. 32.5) and mean blood loss 192ml (S.D. 178). Mean excised tissue was 47.6g (S.D. 30). Neither conversions to open prostatectomy nor transfusions were required. The urethral catheter remained in place an average of 3.0 days (S.D. 2.4) in 14 patients, while 4 needed a re-catheterization. Mean postoperative hospital stay was 5.9 days (S.D. 5.5). Five patients (27.7%) presented complications during follow-up, mild in most of the cases but one who required a secondary intervention for persistent obstruction.
Conclusions: Laparoscopic extraperitoneal adenomectomy (Millin's procedure) is feasible with a reasonable complication rate. Although comparison with open adenomectomy is not yet available, this technique might have potential advantages in terms of blood loss and postoperative catheter time.