Technical Caveats And Tips

An important technical caveat is that subcapsular dissection should proceed in close contact with the whitish surface of the prostatic adenoma, with this plane being further developed bluntly with a combination of J-hook electrocautery, harmonic scalpel, Sotelo prostatome, or suction-irrigation cannula tip. Small vessels entering the adenoma can thus be precisely identified and electrocoagulated.

FIGURE9 ■ The prostatotome. A metallic curvilinear-tip laparoscopic instrument with a sharp cold-knife in the distal side of the forceps to facilitate the enucleation of the adenoma.

FIGURE9 ■ The prostatotome. A metallic curvilinear-tip laparoscopic instrument with a sharp cold-knife in the distal side of the forceps to facilitate the enucleation of the adenoma.

TABLE S ■ Laparoscopic Simple Prostatectomy: Literature Review

Title

Author

Reference

Laparoscopic retropubic simple prostatectomy-

Sotelo et al.

(22)

Laparoscopic prostatectomy with vascularcontrol

Mariano et al.

(18)

for BPH

Laparoscopic extraperitonealadenomectomy (Millin)

van Velthoven et al.

(20)

pilot study on feasibility

Preperitoneal laparoscopic simple prostatectomy

Nadler et al.

(21)

Laparoscopic simple prostatectomy

Baumert et al.

(19)

Novedosa técnica para la creación del espacio

Sotelo et al.

(23)

prevesical en el abordaje extraperitoneal

durante la cirugía laparoscópica de próstata

Retropubic prostatectomy

Millin

(2)

Abbreviation: BPH, benign prostatic hypertrophy.

TABLE 7 ■ Comparison of Series Results and Case Reports of Laparoscopic Simple Prostatectomy

Authors

No. of patients

Bloodloss (cc)

Operative time (min)

Hospital stay

Mean weight specimen (g)

Foley duration

AUA score preoperative

AUA score postoperative

max postoperative

Mariano et al.

1

800

225

4

120

NA

NA

NA

NA

NA

Baumert et al.

20

412

NA

4

NA

4

NA

NA

NA

NA

van Vethoven et al.

18

192

145

5.9

47.6

3

NA

NA

4.3

17.9

Nadler et al.

1

300

350

3

170

10

21

NA

NA

NA

Sotelo et al.

17

516

156

2

72

6.3

24.5

9.9

7

22.8

Abbreviation: AUA,American Urology Association; NA, data not available.

Maintaining a thick prostate capsule is important to minimize violation of the subcapsular venous plexus. Using this technique we have not encountered significant hemorrhage from the prostatic vessels entering the prostatic capsule at the 4 o'clock and 8 o'clock positions.

Attempting to extract the entire prostatic lobe intact may actually impair visualization, contributing to increased blood loss. Hence, piecemeal excision of the already mobilized part of the adenoma provides superior visualization of the remaining part of the adenoma, allowing better hemostasis.

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