title: "Knotless" laparoscopic extraperitoneal adenomectomy.
abstract: BACKGROUND
  Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation.
  
  
  METHODS
  A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision.
  
  
  RESULTS
  The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor.
  
  
  CONCLUSIONS
  "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique.
authors.affiliation: Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España. Electronic address: agarciasegui@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Garcia-Segui
authors.affiliation: Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España.
authors.forename: A
authors.initials: A
authors.lastname: Verges
authors.affiliation: Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Galán-Llopis
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Garcia-Tello
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Ramón de Fata
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Angulo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006488:Hemostasis, Surgical; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011183:Postoperative Complications; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D059708:Ultrasonic Surgical Procedures; D001743:Urinary Bladder / Q000601:surgery
keywords: Adenomectomía laparoscópica; Barbed suture; Benign prostatic hyperplasia; Efectividad; Efficacy; Hipertrofia prostática benigna; Laparoscopic adenomectomy; Safety; Seguridad; Sutura barbada