Laparoscopy-assisted penile revascularization: a new method

Analysis of more than 100 penile revascularizations using the Mannheim modification showed a success rate as high as 82% in properly selected patients. However, the dissection of the epigastric artery requires a relatively large incision, with the risk of postoperative bleeding, pain, and hernia formation. Therefore, we designed a laparoscopic approach for dissection of the epigastric vessels. From January 1995 to October 1996, we performed laparoscopy-assisted penile revascularization in 15 pharmacotesting nonresponders with erectile dysfunction. The first step is dissection of the penile vessels to minimize the occlusion time of the epigastric arteries. Thereafter, the extraperitoneal cavity is exposed using a balloon-trocar system inserted via a 15-mm suprapubic incision. A pneumoextraperitoneum is established, and two further cannulas are inserted (10 mm subumbilical, 5 mm in the lower abdomen contralateral to the desired epigastric artery). The dissection of the epigastric vessels starts caudally at the origin from the external iliac vessels and continues to the periumbilical area. All branches are dissected between clips, keeping the artery and vein together. For extraction of the artery, we insert another 5-mm port through the incision at the penile base. After desufflation of the extraperitoneal space and closure of the trocar wounds, microsurgical penile revascularization is performed using the previously described modification of the Hauri procedure. The mean operating time for laparoscopic dissection of epigastric artery was 120 minutes. No intraoperative complication occurred. One patient suffered from an inguinal hematoma. After a median follow-up of 12 month, 53% of patients showed spontaneous erections, and another 27% achieved a full erection with the aid of additional pharmacotherapy. Laparoscopic dissection of the epigastric arteries proved to be feasible, resulting in a considerable reduction of overall morbidity of penile revascularization without reducing the efficacy of the procedure.