Extraperitoneal Video-Assisted Simple Prostatectomy: A Surgery for Beginners?

Abstract

Introduction and Objectives: Laparoscopic simple prostatectomy has been introduced with the purpose of reducing the morbidity or the classical and standard open surgeries. The extraperitoneal (préperitoneal) or preperitoneal approach adds no technical difficulty and additionally allows no surgical violation of the peritoneum. The purpose of this work (video) is to show a step-by-step video of the simple extraperitoneal prostatectomy technique and present a series of cases of patients treated with this surgery with residents as first surgeons.

Methods: An educational video shows in a didactic way the simple extraperitoneal prostatectomy. The results of a series of 18 consecutive cases are presented. Demographic data and main perioperative outcomes were registered and analyzed. Preoperative and postoperative International Prostate Symptom Score and maximum flow rate were registered as indicators of relieving of bladder outlet obstruction (BOO). A questionnaire for surgery feasibility was answered by the surgeons.

Results: An educational video that shows in a didactic way the simple extraperitoneal simple prostatectomy is presented. Eighteen consecutive cases operated using this technique were analyzed. Mean prostate volume was 98?cc. Mean estimated blood loss was 150?mL (no transfusions were required). No intraoperative complications and no conversion were recorded. Mean length of hospital stay was 3.5 days. Postoperative complications occurred in 5.6% rate (self-limiting prolonged hematuria). A significant improvement was observed for subjective and objective indicators of BOO (p?<?0.05). Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of this analysis. The surgeons' assessment reveals that the technique was easy to perform.

Conclusions: This work proved that the extraperitoneal simple prostatectomy is a safe and effective procedure and certainly a good option for the surgical treatment of high-volume benign prostatic hyperplasia. Finally, in our opinion this surgery appears to be a good procedure for beginners undergoing laparoscopic training, because of its almost absence of oncologic concern and its feasibility.