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Laparoscopic vs open transcapsular adenomectomy (Millin): a comparative study of perioperative outcomes and
Gonçalo Mendes1, Alexandra Rocha1, Bernardo Lobão Teixeira1
1Department of Urology, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
Introduction:
Laparoscopic adenomectomy for prostates larger than 80 mL is still a topic of debate. The purpose of this study is to evaluate the perioperative outcomes and complications between open Millin (OM) and laparoscopic Millin (LM) adenomectomy.
Material And Methods:
Perioperative data and complications were retrospectively collected from patients submitted to Millin procedure from August 2019 to August 2022 in a tertiary centre, and OM and LM were compared. Complications were classified according to Clavien-Dindo classification.
Results:
A total of 205 patients were identified, 125 in the OM group and 80 in the LM group. Baseline characteristics were similar between the groups. Mean total blood loss (194 ±210 vs 477 ±389 mL, p <0.001), mean haemoglobin drop (1.40 ±1.16 vs 2.62 ±1.42 g/dL, p <0.001), duration of catheterisation (4.63 ±1.39 vs 5.37 ±1.99 days, p = 0.004), and hospital stay (4.59 ±1.72 vs 5.82 ±3.36 days, p = 0.003) were significantly lower in the laparoscopic group. The mean operative time was longer in the laparoscopic group (109.9 ±33.4 vs 68.7 ±18.0 min, p <0.001). The overall complication rate was significantly lower in the laparoscopic group (18.8% vs 36.8%; p = 0.012), and this difference was maintained only in Clavien-Dindo groups I (3.8% vs 13.6%; p = 0.018) and II (12.5% vs 21.6%; p = 0.049). Regarding individual complications, patients in the LM group had significantly less haematuria (1.3% vs 8.8%, p = 0.031), wound infections (0% vs 4.8%, p = 0.047), and blood transfusions (0% vs 6.4%, p = 0.024).
Conclusions:
Laparoscopic Miilin adenometomy is a safe technique, with less intraoperative blood loss, shorter length of hospital stay and catheterisation time, and fewer complications, including a lower transfusion rate, than its open counterpart.
Insights
Laparoscopic Millin adenomectomy offers improved outcomes for large prostates compared to open surgery. This technique results in less blood loss, shorter hospital stays, and fewer complications, making it a safer alternative.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic adenomectomy for large prostates (>80 mL) remains a subject of clinical debate.
- Comparing perioperative outcomes of open and laparoscopic approaches is crucial for patient care.
Purpose of the Study:
- To evaluate and compare perioperative outcomes and complication rates between open Millin (OM) and laparoscopic Millin (LM) adenomectomy for large prostates.
- To determine the safety and efficacy of the laparoscopic approach in this patient cohort.
Main Methods:
- Retrospective analysis of perioperative data and complications from patients undergoing the Millin procedure (August 2019 - August 2022).
- Comparison between open Millin (OM) and laparoscopic Millin (LM) groups, with complications classified using the Clavien-Dindo system.
Main Results:
- The laparoscopic group (80 patients) showed significantly lower mean blood loss (477 vs 194 mL), haemoglobin drop, catheterisation duration (4.6 vs 5.4 days), and hospital stay (4.6 vs 5.8 days) compared to the open group (125 patients).
- Overall complication rates were lower in the LM group (18.8% vs 36.8%), specifically for Clavien-Dindo I and II complications.
- The LM group experienced less haematuria, wound infections, and need for blood transfusions.
Conclusions:
- Laparoscopic Millin adenomectomy is a safe and effective procedure for large prostates.
- The laparoscopic approach offers significant advantages over open surgery, including reduced blood loss, shorter recovery times, and a lower complication profile.
