Laparoscopic extraperitoneal adenomectomy (Millin): pilot study on feasibility

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Techniques

Background:

• Benign prostatic hyperplasia (BPH) often necessitates surgical intervention for obstructive symptoms.
• Traditional open adenomectomy, while effective, carries risks of significant blood loss and prolonged recovery.
• Exploring minimally invasive alternatives like laparoscopic surgery is crucial for improving patient outcomes.

Purpose of the Study:

• To describe the surgical technique of laparoscopic extraperitoneal adenomectomy.
• To assess the feasibility and safety of this approach in a pilot study.
• To evaluate key operative parameters and short-term follow-up data.

Main Methods:

• Eighteen patients with objective signs of obstruction underwent laparoscopic extraperitoneal adenomectomy.
• The technique involved creating a preperitoneal workspace, securing hemostasis, performing a capsular incision, enucleating the adenoma, and meticulous closure.
• Feasibility was assessed by operative time, blood loss, transfusion requirements, and complications.

Main Results:

• The mean operative time was 145 minutes with an average blood loss of 192 ml.
• No conversions to open surgery or blood transfusions were required.
• Postoperative catheterization averaged 3.0 days, with a mean hospital stay of 5.9 days; 27.7% experienced mild complications.

Conclusions:

• Laparoscopic extraperitoneal adenomectomy (Millin's procedure) is a feasible surgical option.
• The technique demonstrates a reasonable complication rate.
• Potential advantages include reduced blood loss and shorter postoperative catheterization duration compared to open adenomectomy.