Zia Hamidreza, Khatami Fatemeh, Aghamir Seyed Mohammad Kazem
Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Ann Med Surg (Lond). 2021 Sep 4;69:102787. doi: 10.1016/j.amsu.2021.102787. eCollection 2021 Sep.
and importance: Laparoscopy is a known technique for simple prostatectomy using intraperitoneal or extraperitoneal approaches. In the present study, a novel method is suggested for easier access to the whole body and even the head of the adenoma.
This method was performed on 6 patients with prostate hyperplasia. This was intraperitoneal method, started with 4-6 trocars and two transverse incisions on both sides of the endopelvic fascia. the prostate capsule is detected (using a Foley catheter balloon); the prostate capsule is transversely opened by a U-shape incision in a 0.5-1cm distance from the bladder neck to reach the adenoma and is dissected under the capsule to separate the capsule from the prostate. By ligashour capsule is opened laterally to the endopelvic fascia and separated from the prostate and gland is removed.
The mean operation time was 114 minutes and the average intraoperative bleeding was 244.1 cc. IPSS (International Prostate Symptom Score), Q Max, and post-void residue, changes were significant with p-value = 0.003, respectively; however, pre and postoperative Hemoglobin was imprecise. The mean postoperative urinary leakage is reported at 22 cc.
In short, this technique provides a better vision to prostate adenoma and the results can be compared with other laparoscopic approaches. Yet, larger sample sizes in different centers are required for determining realistic results.
及重要性:腹腔镜检查是一种已知的用于单纯前列腺切除术的技术,可采用腹腔内或腹膜外途径。在本研究中,提出了一种新方法,以便更轻松地触及整个腺体甚至腺瘤头部。
对6例前列腺增生患者实施了该方法。这是一种腹腔内方法,始于4 - 6个套管针以及盆腔内筋膜两侧的两个横向切口。(使用福莱导尿管球囊)检测前列腺包膜;在距膀胱颈0.5 - 1厘米处作U形切口横向打开前列腺包膜以触及腺瘤,并在包膜下进行解剖以将包膜与前列腺分离。通过结扎器将包膜向盆腔内筋膜外侧打开并与前列腺分离,然后切除腺体。
平均手术时间为114分钟,平均术中出血量为244.1毫升。国际前列腺症状评分(IPSS)、最大尿流率(Q Max)和残余尿量的变化具有显著意义,p值分别为0.003;然而,术前和术后血红蛋白情况不确切。术后平均尿漏量报告为22毫升。
简而言之,该技术能更好地观察前列腺腺瘤,其结果可与其他腹腔镜手术方法相比较。然而,需要不同中心更大的样本量来确定实际效果。