Preoperative Preparation

The patient should always be informed on the potential for open conversion should technical difficulties or complications not readily manageable by laparoscopic occur. The patient should also be advised of alternatives (open or transurethral surgery). Informed consent must be obtained.

TABLE 1 ■ Indications

Patients with symptomatic BPH with TRUS estimated gland weight of 60 g or more Patients with obstructive prostatomegaly and associated surgical pathology such as multiple or large bladder calculi, inguinal hernia, large diverticula, a severe ankylosis of the hip that impairs the position of the patient that is required for transurethral resection

Abbreviations: BPH, benign prostatic hypertrophy; TRUS, transrectal ultrasound.

TABLE2 ■ Relative and Absolute Contraindications

Relative contraindications Gross obesity

Significant previous intraperitoneal or preperitoneal surgery Abdominal wall infection Bowel obstruction Absolute contraindications Uncorrectable coagulopathy Cardiopulmonary contraindication Severe obstructive airway disease Morbid obesity

TABLE3 ■ Preoperative Evaluation

History-physical examination Routine laboratory test PSA

IPSS and QoL Uroflowmetry TRUS

Abbreviations: IPSS and QoL, International Prostate Symptom Score and Quality of Life questionnaires; TRUS, transrectal ultrasound; PSA, prostate specific antigen.

As part of the preoperative workup, all patients should have a complete history and physical examination. Preoperative evaluation includes digital rectal exam, routine laboratory tests including prostate specific antigen, International Prostate Symptom Score and Quality of Life questionnaires, Uroflowmetry, and transrectal ultrasonography with measurement of prostate volume. Blood typing and cross-match should be performed (Table 3). Preoperative preparation is listed in Table 4.

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