"Knotless" laparoscopic extraperitoneal adenomectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Laparoscopic adenomectomy is an established procedure for benign prostatic hyperplasia (BPH).
• Progressive simplification has led to techniques like "knotless" laparoscopic adenomectomy.
• This study evaluates the efficacy and safety of the knotless technique in clinical practice.

Purpose of the Study:

• To assess the effectiveness of "knotless" laparoscopic adenomectomy.
• To evaluate the safety profile of this simplified surgical approach.
• To demonstrate the reproducibility of the technique in a clinical setting.

Main Methods:

• Prospective, multicenter, descriptive study of 26 patients with large BPH (>80cc).
• Extraperitoneal laparoscopic technique using 4 trocars, ultrasonic scalpels, and barbed sutures.
• Key steps include hemostatic enucleation, direct vision urethral sectioning, and capsulorrhaphy.

Main Results:

• The study included patients with a mean prostate volume of 127cc.
• Mean operative time was 136 minutes with a mean estimated blood loss of 200cc.
• All patients showed improved urinary function and quality of life, with a low complication rate (6/26 patients, 5 minor).

Conclusions:

• "Knotless" laparoscopic adenomectomy is a low-complexity procedure.
• It combines benefits of open surgery (functional results) with laparoscopic advantages (reduced bleeding, shorter stay).
• Ultrasonic scalpels and barbed sutures enhance safety, hemostasis, and procedural simplicity.