Considering that improvement of the obstructive symptoms is related to the amount of tissue that has been extracted and that transurethral resection of the prostate may be unable to extract large enough volumes in the case of large prostates (12), transvesical prostatectomy indeed improves obstructive symptoms efficiently. Newer transurethral techniques have been devised and developed to excise the largest possible amount of prostatic tissue. The use of the Holmium laser for this purpose has paved the way for the application of this principle (13,14). Using this technique, the adenoma is precisely dissected from the surgical capsule in the cleavage plane between the adenoma and the capsule in a retrograde direction. Hemostasis is achieved at the bleeding points with the wavelength of the laser beam. The resected fragments are deposited in the bladder, from where they are finally extracted with a transurethral morcellator (7,13-16).

The results of randomized prospective studies comparing transvesical prostate adenomectomy and transurethral prostate enucleation using Holmium laser evidenced a similarly significant improvement in the maximum urinary flow and in the volume of residual urine, as measured using the American Urology Association symptom score. Although surgical time was significantly longer in the Holmium group, blood loss, length of catheterization, and hospital stay were significantly shorter. The volume of extracted tissue was similar in both groups (6,7,15,16).

Persistence of the irritative symptoms due to the presence of residual, heat-damaged prostate tissue occurs more frequently after minimally invasive procedures (11). Chen et al. showed that the reduction of the prostate volume after transurethral resection of the prostate proportionally correlates to the rates of American Urology Association symptomatic score improvement (17). However, as shown by Roehrborn et al. in a cooperative study on the guidelines for the diagnosis and treatment of benign prostatic hypertrophy, the average resected tissue was only 22 g (1). Further, in a comparison between transurethral resection of the prostate and Holmium laser performed by Gilling et al., the estimated resected specimen weight was 15.5 and 21.7 g, respectively (14).

Indications for the laparoscopic surgery are constantly growing and expanding. Indeed, the benefits of this approach, including lower morbidity, limited pain, shorter hospital stay, and earlier return to normal working activities, have been largely proven. Thus, laparoscopic retropubic prostatectomy has the potential to combine the advantages of the minimally invasive techniques with the favorable results of open surgery.

Mariano et al. first reported laparoscopic simple prostatectomy performed in a patient with benign prostatic hypertrophy. A total of four hemostatic sutures were used for vascular control (18). Baumert et al. performed laparoscopic simple prostatectomy in 20 patients (19). van Velthoven et al. reported their initial experience with laparoscopic extraperitoneal Millin's prostatectomy in 18 patients (20). Nadler et al. recently reported preperitoneal laparoscopic approach for resection of a large prostatic adenoma in one patient (21). Sotelo et al. described their technique of laparoscopic simple retropubic prostatectomy in 17 patients with symptomatic significant prostatomegaly (>60 g on transrectal ultrasonography, mean 93 g) (22).

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