title: Extraperitoneal laparoscopic prostatectomy (adenomectomy) for obstructing benign prostatic hyperplasia: transvesical and transcapsular (Millin) techniques.
abstract: OBJECTIVE
  We describe extraperitoneal laparoscopic resection of large prostatic adenomas (<100 g) as an alternative to open simple prostatectomy by both the transcapsular or Millin and the transvesical approaches.
  
  
  METHODS
  We have performed more than 20 laparoscopic prostatectomies (adenomectomies) for benign prostatic hyperplasia (BPH) for glands >100 g. The initial two cases, with follow-up longer than 1 year, are included in this report. Using an extraperitoneal approach, enucleation of the obstructing prostatic lobes was performed with the aid of a Harmonic Scalpel and laparoscopic claw forceps. Hemostatic sutures were placed at 5 and 7 o'clock. The urethrovesical junction (transvesical) or capsulotomy (Millin) were closed in an interrupted fashion using intracorporeal sutures.
  
  
  RESULTS
  Both procedures were successful. The total operative time was 180 minutes for first the case and 120 minutes for the second. The adenoma removed was approximately 138 g in the first case and 102 g in the second case. The estimated blood loss was <50 mL and <200 mL, respectively. The postoperative courses were unremarkable. Analgesic requirements were minimal, and the patient was discharged on postoperative day 2 and 3, respectively. A follow-up examination at 1, 3, 6, and 12 months showed that the flow rate is >20 mL and the postvoiding residual volume 0, with normal continence and sexual potency in both men.
  
  
  CONCLUSIONS
  Extraperitoneal laparoscopic simple prostatectomy is a simple straightforward technique. Minimal bleeding, a reduced transfusion rate, shorter hospitalization, and faster recovery are additional advantages. This minimally invasive technique is a reasonable alternative to open simple prostatectomy for large glands with reduced morbidity.
authors.affiliation: Department of Urology, School of Medicine, SUNY-Stony Brook University Medical Center, Stony Brook, New York 11794-8093, USA. jarehman@notes.cc.sunysb.edu
authors.forename: Jamil
authors.initials: J
authors.lastname: Rehman
authors.forename: Sardar A
authors.initials: SA
authors.lastname: Khan
authors.forename: Troy
authors.initials: T
authors.lastname: Sukkarieh
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Waltzer
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D002404:Catheterization; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011098:Polyglactin 910; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000601:surgery*; D013537:Sutures
chemical_list: D011098:Polyglactin 910