Simple Prostatectomy Technique

Abstract

Introduction:

Benign prostatic hyperplasia is the most common benign tumor among male population. Classically for glands larger than 80 g, urologists worldwide usually indicate surgery as a gold standard treatment. The procedure intends to remove the prostatic adenoma through open or, more recently, minimally invasive approach. The benefits of laparoscopic access are well described in the literature in a variety of surgeries. For simple prostatectomy, distinctive surgical techniques have been described.

Objectives:

To describe different techniques and tips to perform a laparoscopic simple prostatectomy.

Materials and Methods:

We have evaluated our series of cases of laparoscopic simple prostatectomy and assembled some key points of distinctive techniques in this compilation. We have organized our video in different surgical steps for a better technique description. Our video described six different surgical stages namely in access, bladder presentation, prostate dissection, prostate presentation, hemostasis, and bladder closure.

Results:

We have illustrated three different accesses (transperitoneal, extraperitoneal, and transvesical) and two different types of bladder presentation (bilateral simple suspension stitch or bilateral bowline-type knot). Prostate dissection with laparoscopic prostate enucleator, harmonic scapel, laparoscopic scissors, or a combination of those tools is demonstrated. To provide a better prostate presentation, a prostate suspension stitch or a laparoscopic claw grasping forceps was used. We manage the hemostasis with a foley catheter cuff insufflation at the prostate site, barbed suture during the trigonization, or harmonic scapel while dissecting the prostate adenoma. We performed the bladder closure with absorbable running suture.

Conclusions:

Laparoscopic simple prostatectomy is feasible and has been performed worldwide. Different techniques and approaches have been described in the literature. We believe that the steps and tips illustrated in this video are key points to improve the outcomes and minimize the complications in this type of surgery.

No competing financial interests exist.

Runtime of video: 6 mins 58 secs