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Transcapsular adenomectomy(Millin): a comparative study, extraperitoneal laparoscopy versus open surgery
Francesco Porpiglia1, Carlo Terrone, Julien Renard
1Department of Urology, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy. porpiglia@libero.it
Objective:
To demonstrate the safety of the Millin extraperitoneal laparoscopic adenomectomy by comparing the laparoscopic and open approaches.
Methods:
From January 2003 to April 2005, patients, with indication of prostatic adenomectomy, were offered the chance to choose between 2 types of procedure: Millin adenomectomy with open or extraperitoneal laparoscopic approach. Forty patients were included in this prospective non-randomised study. The patients were divided into 2 Groups. Group A (20 patients) underwent extraperitoneal laparoscopic adenomectomy, while Group B (20 patients) was treated by open surgery. Pre-operative, peri-operative and post-operative parameters were evaluated. Group A was subdivided in two sub-groups (first ten and last ten) and peri-operative parameters were considered in order to determine the learning curve.
Results:
In terms of pre-operative parameters considered, the 2 study groups are comparable (p>0.3). As far as peri and post-operative parameters are concerned: mean blood loss for Group A was 411.6+/-419 ml, for Group B 687.5+/-298.6 ml (p=0.004). For all the other parameters no significant statistical differences were recorded (p>0.4). Mean operative time was 107.2+/-34.9 min in Group A, and 95.5+/-22.5 min in Group B. Mean adenoma weight in Group A was: 69,5+/-21.5 g, in Group B: 88.1+/-43.8 g. Mean haemoglobin levels in Group A was: 11.2+/-1.8 g/dl, Group B: 11.6+/-1.2 (10-13.4) g/dl. Mean Analgesic consuming (Tramadol) during the post-operative stay was 385+/-36 mg in Group A, versus 430+/-108 mg in Group B. Mean catheterization time was 6.3+/-3.7 days in Group A, 5.6+/-1.1 days in Group B. The mean hospital stay was 7.8+/-4.1 days in Group A, and 7+/-1.6 days in Group B. One patient (5%) from Group A was re-operated for bleeding and clot retention, whilst in Group B patients did not present complications which required any further intervention. As far as peri-operative and post-operative parameters of the two sub-Groups A (first ten patients and last ten patients) are concerned, the statistical evaluation shows a significant difference only on operative time (p=0.01). The p-value for the other parameters was not significant (p>0.1).
Conclusions:
The extraperitoneal laparoscopic adenomectomy is a safe technique presenting results comparable to open surgery with the advantage of significantly lower peri-operative blood loss.
Insights
The extraperitoneal laparoscopic adenomectomy is a safe and effective surgical option for treating benign prostatic hyperplasia. This minimally invasive approach offers comparable outcomes to open surgery with significantly reduced blood loss.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Benign prostatic hyperplasia (BPH) is a common condition requiring surgical intervention.
- Traditional open prostatectomy carries risks of significant blood loss and prolonged recovery.
- Laparoscopic techniques offer potential advantages in reducing surgical morbidity.
Purpose of the Study:
- To evaluate the safety and efficacy of Millin extraperitoneal laparoscopic adenomectomy.
- To compare peri-operative and post-operative outcomes between laparoscopic and open adenomectomy.
- To assess the learning curve associated with extraperitoneal laparoscopic adenomectomy.
Main Methods:
- A prospective, non-randomized study included 40 patients undergoing prostatic adenomectomy.
- Patients were divided into two groups: 20 underwent extraperitoneal laparoscopic adenomectomy (Group A) and 20 underwent open surgery (Group B).
- Pre-operative, peri-operative, and post-operative parameters were meticulously evaluated. Group A was further analyzed to determine the learning curve.
Main Results:
- Both groups were comparable in pre-operative parameters (p>0.3).
- Group A demonstrated significantly lower mean blood loss (411.6 ml) compared to Group B (687.5 ml) (p=0.004).
- No significant differences were observed in operative time, adenoma weight, hemoglobin levels, analgesic consumption, catheterization time, or hospital stay (p>0.4). One patient in Group A required re-operation for bleeding.
Conclusions:
- Extraperitoneal laparoscopic adenomectomy is a safe surgical technique for BPH.
- It achieves comparable results to open surgery.
- The primary advantage is significantly reduced peri-operative blood loss, enhancing patient recovery.