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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

Laparoscopic enucleation of adenoma tissue from the surgical capsule.
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Figure 0002: Laparoscopic enucleation of adenoma tissue from the surgical capsule.

Mentions: The prostatic capsule is opened 3–4 cm transversally and 1 cm distal to the bladder neck. The puboprostatic ligaments are avoided to prevent bleeding from the dorsal vascular plexus. Hemostatic sutures are placed at the 5 and 7 o'clock positions [19]. The capsular incision is carried to a depth that first reveals the off–white tissue of the adenoma [17]. Monopolar scissors and the suction–irrigation cannula are used to develop the plane between the prostatic adenoma and the capsule (Figure 2). The anterior plane is then developed, followed by lateral and posterior dissection. In some cases, where improved exposure is required, the incision is extended in the shape of an inverted “T” on the prostatic capsule [21]. To enucleate the lateral lobes, a circumferential incision is made in the urethral mucosa at the bladder neck. The lateral lobes are grasped using a laparoscopic claw grasper. A harmonic scalpel is used to develop the surgical avascular capsular plane in the distal projection towards the apex, the lateral projection to the posterior plane, and the cranial projection to the bladder neck, in a fashion similar to that used in open surgery. In a modified version of the procedure, two lateral stay sutures are used between the cut prostatic capsule and the Cooper ligament, providing a clear visualization of the fossa and the cleavage plan [11].


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)

Laparoscopic enucleation of adenoma tissue from the surgical capsule.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Laparoscopic enucleation of adenoma tissue from the surgical capsule.
Mentions: The prostatic capsule is opened 3–4 cm transversally and 1 cm distal to the bladder neck. The puboprostatic ligaments are avoided to prevent bleeding from the dorsal vascular plexus. Hemostatic sutures are placed at the 5 and 7 o'clock positions [19]. The capsular incision is carried to a depth that first reveals the off–white tissue of the adenoma [17]. Monopolar scissors and the suction–irrigation cannula are used to develop the plane between the prostatic adenoma and the capsule (Figure 2). The anterior plane is then developed, followed by lateral and posterior dissection. In some cases, where improved exposure is required, the incision is extended in the shape of an inverted “T” on the prostatic capsule [21]. To enucleate the lateral lobes, a circumferential incision is made in the urethral mucosa at the bladder neck. The lateral lobes are grasped using a laparoscopic claw grasper. A harmonic scalpel is used to develop the surgical avascular capsular plane in the distal projection towards the apex, the lateral projection to the posterior plane, and the cranial projection to the bladder neck, in a fashion similar to that used in open surgery. In a modified version of the procedure, two lateral stay sutures are used between the cut prostatic capsule and the Cooper ligament, providing a clear visualization of the fossa and the cleavage plan [11].

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