[Comparative study between laparoscopic extraperitoneal and open adenomectomy]

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Open adenomectomy remains the standard for large prostate adenomas despite advancements in endoscopic procedures.
• Laparoscopic and robotic techniques show promise but require specialized expertise.
• Laparoscopic extraperitoneal adenomectomy (LEA) offers a minimally invasive approach for benign prostatic hyperplasia (BPH).

Purpose of the Study:

• To evaluate the outcomes of LEA performed in a regional center.
• To prospectively compare LEA with traditional open surgery for BPH treatment.
• To assess the feasibility, safety, and advantages of LEA.

Main Methods:

• A prospective comparative study involving 46 patients with BPH (prostate >80g).
• 17 patients underwent LEA using a 4-trocar extraperitoneal technique with an ultrasonic scalpel.
• 18 patients underwent open surgery; 11 initial LEA cases were excluded from comparison.

Main Results:

• No significant differences in patient demographics, prostate volume, or functional outcomes (uroflow, IPSS, QoLs) between LEA and open surgery groups.
• LEA demonstrated significantly shorter operation times, less intraoperative bleeding, reduced irrigation time, shorter catheter indwelling, and decreased hospital stay.
• The open surgery group had a higher incidence of hemorrhagic and wound complications, and a 22.2% transfusion rate compared to 0% in the LEA group.

Conclusions:

• Laparoscopic extraperitoneal adenomectomy (LEA) is a complex but feasible and safe alternative for treating large prostate adenomas.
• LEA offers significant advantages over open surgery, including reduced complications and faster recovery.
• Laparoscopic skills are essential for successful implementation of LEA.