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Endoscopic simple prostatectomy.

Sosnowski R, Borkowski T, Chłosta P, Dobruch J, Fiutowski M, Jaskulski J, Słojewski M, Szydełko T, Szymański M, Demkow T - Cent European J Urol (2014)

Bottom Line: These operative techniques have been standardized and reproducible, with some individual modifications.Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery.These procedures have a short learning curve and offer new options for the surgeon treating BPH.

View Article: PubMed Central - PubMed

Affiliation: Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.

ABSTRACT

Introduction: Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH.

Material and methods: We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH.

Results: Laparoscopic adenomectomy (LA) and robotic-assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work.

Conclusions: Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH.

No MeSH data available.


Related in: MedlinePlus

Location of the ports during extraperitoneal laparoscopic adenomectomy.
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Figure 0001: Location of the ports during extraperitoneal laparoscopic adenomectomy.

Mentions: Several laparoscopic techniques are used to create a preperitoneal space. One technique involves an incision under the umbilicus with carbon dioxide insufflation into the extraperitoneal space via a Veress needle to 12 mmHg [19]. A second technique involves making a 2–cm vertical midline incision above the pubic arch followed by blunt dissection of the preperitoneal and Retzius space with an index finger and a 700–mL self–dilating balloon [2]. In a third technique, the preperitoneal space is created after insertion of a balloon dissector. The retroperitoneal space is then bluntly dissected with an 800–1200–mL infusion of sterile saline solution into the balloon [4]. A Hasson trocar is introduced under the umbilicus. The operation can also begin with the primary insertion of a 10–mm infraumbilical port and laparoscope. Then, dissection of the preperitoneal space is completed with the aid of the laparoscope and insufflation. Usually, 4 trocars, 5 mm or 12 mm, are inserted in a fan shape, to introduce a needle for suturing, as in extraperitoneal radical prostatectomy [4]. A single 10–mm port is inserted infraumbilically as the camera port (Figure 1). The pneumoextraperitoneum is usually created at 12 mm Hg. The pelvic fascia and the anterior wall of the prostate are exposed. The dorsal vein complex is assessed and then carefully coagulated using bipolar forceps cranially, keeping an appropriate distance from the puboprostatic ligaments. In a fourth technique, two hemostatic sutures are applied to these vessels [2]. Using the bladder catheter or a special metal guide inserted into the urethra as a reference point, the interface between the bladder neck and prostate base is identified. If necessary, two cross–stitch hemostatic sutures are placed on the lateral surface of the prostate at the level of the bilateral vesicoprostatic vessels.


Endoscopic simple prostatectomy.

Sosnowski R, Borkowski T, Chłosta P, Dobruch J, Fiutowski M, Jaskulski J, Słojewski M, Szydełko T, Szymański M, Demkow T - Cent European J Urol (2014)

Location of the ports during extraperitoneal laparoscopic adenomectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310888&req=5

Figure 0001: Location of the ports during extraperitoneal laparoscopic adenomectomy.
Mentions: Several laparoscopic techniques are used to create a preperitoneal space. One technique involves an incision under the umbilicus with carbon dioxide insufflation into the extraperitoneal space via a Veress needle to 12 mmHg [19]. A second technique involves making a 2–cm vertical midline incision above the pubic arch followed by blunt dissection of the preperitoneal and Retzius space with an index finger and a 700–mL self–dilating balloon [2]. In a third technique, the preperitoneal space is created after insertion of a balloon dissector. The retroperitoneal space is then bluntly dissected with an 800–1200–mL infusion of sterile saline solution into the balloon [4]. A Hasson trocar is introduced under the umbilicus. The operation can also begin with the primary insertion of a 10–mm infraumbilical port and laparoscope. Then, dissection of the preperitoneal space is completed with the aid of the laparoscope and insufflation. Usually, 4 trocars, 5 mm or 12 mm, are inserted in a fan shape, to introduce a needle for suturing, as in extraperitoneal radical prostatectomy [4]. A single 10–mm port is inserted infraumbilically as the camera port (Figure 1). The pneumoextraperitoneum is usually created at 12 mm Hg. The pelvic fascia and the anterior wall of the prostate are exposed. The dorsal vein complex is assessed and then carefully coagulated using bipolar forceps cranially, keeping an appropriate distance from the puboprostatic ligaments. In a fourth technique, two hemostatic sutures are applied to these vessels [2]. Using the bladder catheter or a special metal guide inserted into the urethra as a reference point, the interface between the bladder neck and prostate base is identified. If necessary, two cross–stitch hemostatic sutures are placed on the lateral surface of the prostate at the level of the bilateral vesicoprostatic vessels.

Bottom Line: These operative techniques have been standardized and reproducible, with some individual modifications.Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery.These procedures have a short learning curve and offer new options for the surgeon treating BPH.

View Article: PubMed Central - PubMed

Affiliation: Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.

ABSTRACT

Introduction: Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH.

Material and methods: We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH.

Results: Laparoscopic adenomectomy (LA) and robotic-assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work.

Conclusions: Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH.

No MeSH data available.


Related in: MedlinePlus