Rene Sotelo Noguera and Alejandro Garcia Segui

Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, "La Floresta" Medical Institute, Caracas, Venezuela

INTRODUCTION

Step 7: Prostatic Adenomectomy

PATIENT SELECTION

Step 8: Trigonization of the Prostatic

PREOPERATIVE PREPARATION

Fossa

LAPAROSCOPIC TECHNIQUE

Step 9: Suture Repair of the Cystotomy

Step 1: Patient Positioning

TECHNICAL MODIFICATIONS

Step 2: Creation of the Preperitoneal Space

PROS AND CONS OF VARIOUS TECHNIQUES

Step 3: Trocar Placement

TECHNICAL CAVEATS AND TIPS

Step 4: Transverse Cystotomy

SPECIFIC MEASURES TAKEN TO PREVENT

Step 5: Retraction of the Median Lobe

COMPLICATIONS

Step 6: Development of the Subcapsular

REFERENCES

Plane

Open surgery has traditionally been the treatment of choice for benign, symptomatic, large size prostatomegaly.

Size of the prostate gland is an important consideration to select the appropriate surgical approach for the individual patient with symptomatic benign prostatic hypertrophy.

■ Transurethral incision of prostate is efficacious for glands up to 30 cc in size.

■ Transurethral resection of the prostate is the long-established gold standard surgical procedure for the medium-sized adenomas.

■ Glands larger than 80-100 g may be better managed with open simple retropubic prostatectomy, especially in the presence of coexisting pathology, such as large vesical diverticulum, large/multiple bladder calculi, or severe hip ankylosis con-traindicating a lithotomy position.

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