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Extraperitoneal laparoscopic Millin prostatectomy using finger enucleation
Piotr L Chlosta1, Ioannis M Varkarakis, Tomasz Drewa
1Department of Urology, Institute of Oncology, Kielce, Poland.
Purpose:
We evaluated the feasibilty, safety and results of extraperitoneal laparoscopic Millin prostatectomy using finger enucleation through an additional 1 cm suprapubic incision.
Materials And Methods:
A total of 66 consecutive laparoscopic simple prostatectomies were performed with this technique in men with symptomatic bladder outflow obstruction and a prostate gland larger than 70 cc on transrectal ultrasound. Data such as operating time, intraoperative blood loss, transfusion rate, complications, catheterization period, hospitalization time and surgical specimen weight were prospectively collected and evaluated. Preoperative and 3-month postoperative International Prostate Symptom Score and urinary flow rates were used to assess the surgical outcome.
Results:
Average operating time was 55 minutes with a mean estimated blood loss of 200 ml. No blood transfusion was necessary, and no conversion, complications or mortality was present. The mean postoperative catheterization period was 7.3 days with a mean hospital stay of 5.2 days. Mean enucleated tissue weight was 85.5 gm. At 3 months postoperatively the International Prostate Symptom Score improved to a mean of 5.8 (from a mean preoperative score of 29.5) while maximum urine flow improved to a mean of 18.5 ml per second (from a mean preoperative rate of 5.8 ml per second).
Conclusions:
This procedure is safe and fast with excellent functional outcomes. However, prolonged catheterization and hospitalization are still required.
Insights
This study shows extraperitoneal laparoscopic Millin prostatectomy is a safe and effective procedure for benign prostatic hyperplasia, offering excellent symptom relief and improved urinary flow. However, longer catheterization and hospital stays may still be necessary.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Benign prostatic hyperplasia (BPH) significantly impacts quality of life.
- Traditional prostatectomy methods carry risks and longer recovery times.
- Laparoscopic techniques offer potential for reduced morbidity.
Purpose of the Study:
- To assess the feasibility, safety, and outcomes of extraperitoneal laparoscopic Millin prostatectomy.
- To evaluate a technique utilizing finger enucleation via a suprapubic incision.
- To determine the efficacy in patients with large prostates (>70 cc).
Main Methods:
- 66 consecutive patients with symptomatic BPH and large prostates underwent the procedure.
- Data collected included operative time, blood loss, complications, and recovery metrics.
- Symptom scores (International Prostate Symptom Score) and urinary flow rates were assessed preoperatively and postoperatively.
Main Results:
- Average operative time was 55 minutes with minimal blood loss (200 ml).
- No transfusions, conversions, complications, or mortality were reported.
- Significant improvements in International Prostate Symptom Score (29.5 to 5.8) and maximum urine flow (5.8 to 18.5 ml/s) were observed at 3 months.
Conclusions:
- Extraperitoneal laparoscopic Millin prostatectomy is a safe and rapid procedure.
- The technique yields excellent functional outcomes for BPH.
- Prolonged catheterization and hospitalization remain considerations.
