Comparative Study Between Laparoscopic Extraperitoneal and Open Adenomectomy

Abstract

Objectives

In spite of the development of endoscopic techniques, open adenomectomy continues to be the treatment of choice for large adenomas. Laparoscopic and robotic adenomectomy provides good results in specialized centers. The experience acquired with laparoscopic extraperitoneal adenomectomy (LEA) in a regional center is presented to evaluate its results and compare them prospectively with the results of open surgery.

Patients and methods

46 patients with benign prostatic hyperplasia (BPH) (prostate >80g) and an indication for surgery were evaluated. The first 11 patients underwent LEA and were not included in the comparison. Thereafter, the cases were compared; 17 patients underwent LEA and 18, open surgery. In the extraperitoneal technique with 4 trocars, enucleation was performed with an ultrasonic scalpel.

Results

There were no significant differences between groups in age, prostate volume, uroflow (Qmax), International Prostate Symptom Score (IPSS), Quality of Life scale (QoLs). The operation time was significantly greater in the LEA group (135.2 vs. 101.2minutes, p=0.022). Intraoperative bleeding (250 vs. 493.3ml, p=0.004), irrigation time (22.2 vs. 39.1hours, p=0.038), catheter indwelling time (5.5 vs. 7.5 days, p=0.030), hospital stay (3.7 vs. 6.6 days, p=0.006) and transfusion rate (0 vs. 22.2%) were significantly less in the laparoscopy group. There was a greater incidence of hemorrhagic and surgical wound complications in the open surgery group.

Conclusions

LEA is a relatively complex technique that requires laparoscopic skills, but it is a feasible and safe alternative to open surgery and has several advantages.