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about the book . . .

Div ided i r r to eleverr dei : r i led sect iens, t i r is re ierence di ;p lays t i re exper i ise arnd researciro ' i speci : r l i l ls ' r r r- t rn le:rding u rology centers around ' t i re wctr ld arrd o ' i iers au' t i ror i l : r t ivecir : rpfer i on t i re err i i re speccrurn oi urct lctgic l : lparro. t .epy. ' f i re c irapters cev?r rrrei i rod;in p:r i ierr i selec' t iorr , per i -operai iye rnanagerrr3n' t , and cornpl ical ion : ryoidance; ; iep-by-step de;cr ip i ions oi speci i ic lecirrr ic;ues; arnd t i re proi and conl o ' i eacir procedure'rora c lear l ratp oi t i re rrarry pr incipler and prarct icel currenl ly ut i l ized in i i re i ie ld.

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about the editor . . .

f f lDEit i i l i t 5. GILL i ; Proiessor oi iu rg"ry, arrd i - le:rd, seci i on'or Laparoscopic : rrrd i {oLroi icSurg-ery, Gl ick-rnarn Urological l r rs i i iute, Cleyel : r r rd Cl in ic Fourrdar i ic tn, Cleyel : l r rd, c) i r io.i - fe i rars aui i rored er ceaul i rored rno13 l i ran 2E0 peer-rzvievyed scien' t i ' i ic puLr l icart ienJ,50 eoeL cirapiers, arrd t lbctol ' , t . Dr. Gi l l i ra; beerr : r v is i i ing pro' feEEor : ' r r rd i r rv i ied;pea! ' -erat r r rore t i ran 2Q0:rc:rdernic i r rEl i ' tu i ieni and lc ieni i ' i ic rneel i n l t wsr ldvvide, arrd i rarErrrerr iored rnorz i i r : , rn 50 pos' i -gradua' te c l i r r ic : r l : rnd r353arcir ie l lovvs. i le is ?rei ldent,) tyr i t VVcr ld Congress ct f Errdourolegy, 2006. VVidely reco gr ized at a learder . t l c i refore ' r rorr i c i rn in i rnal ly invasive urolcAy, i re speci : r l izes i r r larparescepic lur !"ry o ' i l i readrerral g larrd, k- idn?y, preslaie, arnd i . r ladder.

Printed in the United States cti /\rnericaDKl lqX

ISBN B-8t+1

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LAPAROSCOPI C SI M PLE PROSTATECTO MY

Rene Sotelo Noguera and Alejandro Garcia-SeguiSection of Laparoscopic and Minimally Inaasiae Surgery, DEartment of Urology," La F lorest a" Medical lnstitut e, CarAcAs, Venezuela

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PAIEII$EIEG$$H ,, ,,,'PR EO PERAITVE PR EPARANONIAPAR0SCoPTC TECHNIQUEStep t Patient Fosl$onlng :.,Step 2: Crea$cnOf lfie ftpeiltsnenl SpStep 3: Trocar PlacementStep 4: transverse CystotomyStep 5: Refradion of the Medlan lobeStep 6: Detelspment of the Subeapsular.l:

Plane

Step 7: Prpstatic AdenomectomyStep 8: Trigoniration of ths Pro$atic

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Step 9: Su$rc Repairof $e G$otomyrEcflNtcAt MoDtHc,Anot*s,PRO$AHD cot{s oFvARlot$'ffilNqt rsTECIINiIC/IO4YEAIS{t{D IIPS',. .

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SPECIRC MEASI'RES TAKEN TO PREVEI{fc0MPLrcA'ftot{sREFEREI{CES

Open suqery hasfadltionalty been thebeatmeilt of choie for benign, rynptom-atic, lage size prostatonregafy.

Size of the pnstate $and,is an impor-tant consideration to select the appro-pdate sugical apprcach for theindividual patient with symptomaticbenign pmstatic hypertrophy.r Transuretft ral inelsioil .of Brostate is

efficacious for glands up to 30 cc insrze.

r Transurethral resection of tfieprostate isthe long*Sblished goldstandard surgical procedure for themedium-sized adenomas,

r Glands la€erthan Bg-ttl$g may hebetter managed witi open simpleretmpubic prostatectomy, especiallyin the presenca sf coeNistingpathology, such as large ve*imldiverticulum, large/multiple bladdercalculi, or serrere hip anlcylosis con-traindicating a lithotomy po$tion.

INTRODUCTION

Open surgery has traditionallybeenthe treatment of choice forbenign, symptomatic,largesize prostatomegaly (1).

First described in 1945 by Millin (2), retropubic simple prostatectomy achievescomplete enucleation of the prostate adenoma through a transverse capsulotomy inci-sion on the anterior surface of the prostate gland. Subsequently, transurethral endo-scopic techniques have virtually replaced the open approach in the surgicalmanagement of benign prostatic hypertrophy (3-5). Recent modifications of the goldstandard transurethral resection (transurethral resection of the prostate) includetransurethral needle ablation, thermotherapy, and holmium or "green light" laser enu-cleation. In general, these techniques are applied for small to moderate sized benignprostatic hypertrophy. More recently, the holmium laser has been employed for " gianrt"prostatomegaly, even in excess of 100 g (6,7). Nevertheless, at many centers, openprostatectomy remains the technique of choice for the majority of patients with hugelyenlarged benign prostatic hypertrophy (8,9).

The size of the prostate gland is an important consideration to select the appro-priate surgical approach for the individual patient with symptomatic benign prostatichypertrophy:

r Transurethral incision of prostate is efficacious for glands up to 30 cc in size (8).I Transurethral resection of the prostate is the long-established gold standard surgi-

cal procedure for the medium-sized adenomas.I Glands larger than 80-100 g may be better managed with open simple retropubic

prostatectomy, especially in the presence of coexisting pathology, such as large vesi-cal diverticulum, large/multiple bladder calculi, or severe hip ankylosis contraindi-cating a lithotomy position (9).

Operative morbidity of transurethral resection of the prostate increases when per-formed for prostatic adenoma larger than 45 g, in procedures lasting more than 90 min-utes, or patients older than 80 years or with prior history of acute urinary retention (10,11).

A meta-analysis of the literature concluded that open prostatectomy is the mosteffective method for improving the symptoms of an obstruction caused by benign pro-static hyperplasia, despite being an invasive and expensive procedure. This obstructionis corrected by completely removing the adenoma and this is what guarantees the favor-able results (11,L2).

859

xxii Contents

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Laparoscopic lce Slush Renal HypothermiaEndoscopic Retrograde Cold Saline InlusionTransarterial Renal Hypothermia 838The Laparoscopic Gooling Sheath 839Ancillary Techniques for lschemic Renoprotection 8ggReferences 840

CHAPTER 72: IAPAR0SC0PIC REN0VASCUIAR SURGERY r 841Thomas H. S. Hsu

r Introduction 841I Laparoscopic Aortorenal Bypass 841t Laparoscopic Renal Autotransplanlation 842I Laparoscopic Repair of RenalArtery Aneurysm 843I References 843

CHAPTER 73: IAPAROSCOPIC SURGERY FORTHE HORSESHOE KIDilEY T 845Hyung L, Kim and Peter Schulam

t Introduclion 845r Pyeloplasty 845I Heminephrectomy 847I References 849

CHAPTER 74: I.APAROSCOPIC BOARI FIAP URETEROilEOCYSTOSMMYAND ItEAt URETER REPIACEMENT T 851AmrF,Fergany

I Laparoscopic Boari Flap Ureteroneocyslostomy 851I Laparoscopic lleal Ureter Replacement 852I Relerences 854

CHAPTER 75: TRANSVESICAT IAPAROSCOPIC BIADDER DIVERTICUTECIOMY r 855Vito Pansadoro

I Introduction 855r History of Laparoscopic Diverticulectomy 855r Indications and Gontraindications 855r Surgical Technique 856I Current Data lrom the Literature 857r Complications 857r Advantages and Disadvantages 857t References 857

CHAPTER 76: IAPAROSCOPIC SIMPTE PROSTATECTOMY r 859Rene Sotelo Noguera anil Aleiandro Garcia-Segui

I lntroduction 859t Patient Selection 860I Preoperative Preparation 860I Laparoscopic Technique 861I Technical Modifications 862I Pros and Gons of Uarious Techniques 864r Specilic Measures Taken lo Prevent Gomplications 866I References 866

CHAPTER 77: TEGHNIQUES FOR URETHROVESICAIANIISIOM0SIS 11{ IAPAROSCOPIC RADICAL PROSTATECI0MY r 869Roland F. P. oanVelthooen

t Introduction 869r Patient Positioning 869I Surgeon Positioning 870I Preparation of the Urethral Stump 870I Preparatlon of the Bladder Neck 871I UrethrovesicalAnastomosis in the Montsouris Technique 871I Running Sulure Technique lor Vesicourethral Anastomosis 872r Single Knot Method for the Laparoscopic Running Urethrovesical Anastomosis 874I Discussion 876I References 879

Chapter 76 r Laparoscoplc Slmple Prostatectomy 867

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Lu-Yao GL, Barry Mf, Chang CH, et al. Transurethral resection of the prostate among Medicare ben-eficiaries in the United States: time trends and outcomes. Urology 1994; M:692-496.McNicholas TA. Management of symptomatic BPH in the UK: who is treated and how? Eur Urol1999;36:33-39.Gordon NS, Hadlow G, Knight E, Mohan P. Transurethral resection of the prostate: still the goldstandard. Aust NZ I Surg 1997;67:354-357.Kuntz & Lehrich K. Transurethral holmium laser enuclbation versus transvesical open enucleationfor prostate adenoma greater than L00 g. Arandomized prospective trial of 120 patients.JUrol2o02;768:1465-1469.Moody |A, Lingeman JE. Holmium laser enucleation for prostate adenoma greater than 100 g: com-parison to open prostatectomy. I Urol 2001;165:459.AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyper-plasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol 2003;170:530-547.Han M, Alfert H, Partin A. Retropubic and suprapubic open prostatectomy. In: Walsh PC, RetikAB, Vaughan ED, Wein AJ, eds. Campbell's Urology. Vol. 2. 8th ed. Philadelphia: Saunders(Chapter 41).Tubaro A, Vicentini R, Renzetti R, Miano L. Invasive and minimally invasive treatment modalitiesfor lower urinary tract symptoms: what are the relevant differences in randomized controlled tri-als? Eur Urol2000; 38:7-L7.McConnell |D, Barry MJ, Bruskewitz RC, et al. Benign Prostatic Hyperplasia: Diagnosis andTreatment. Clinical Practice Guideline AHCPR Publications No. 94-0582. Rockville: Agency forHealth Care Policy and Research, Public Health Service, U.S. Department of Health and HumanServices,'1"994.Tubaro A, Carter S, Hind A, Vicentini C, Miano L. A prospective study of the safety and efficacy ofsuprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol 2001;166:172-176.Gilling PJ, Cass CB, Cresswell MD, Fraundorfer MR. Holmium laser resection of the prostate: pre-liminary results of a new method for the treatment of the benign prostatic hyperplasia. Urology1996;47:48.Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmium laser ver-sus transurethral resection of the prostate: a randomized prospective trial with 1-year followup.J Urol 1999 ; 162:1.640-t6M.Kuo RL, Kim SC, Paterson RF, Ligeman JE, Munch LC. Holmium laser enucleation of the prostate(Holep): a minimally invasive altemative to open simple prostatectomy. j Urol2003; suppl 169;11'1.Abstract V430.Kuo RL, Kim SC, Paterson RF, Watkins S, Steele RE, Lingerman |E. Holmium laser enucleation ofthe prostate (Holep): the methodist hospital experience with >75 gram enucleations. J Urol2003;suppl 1,69 ; 389 Abstract 1452.Chen SS, Hong fG, Hsiao Yf, et al. The correlation between clinical outcome and residual prostaticweight ratio alter transurethral resection of the prostate for benign prostatic hyperplasia. BJU Int2000;85:79.Mariano MB, Graziottin TM, Tefilli MV. Laparoscopic prostatectomy with vascular control forbenign prostatic hyperplasia. I Urol 2002; 167 :252U2529.Baumert H, Gholami SS, BermridezH, et al. Laparoscopic simple prostatectomy. J Urol2003; suppl169;109 AbstractV423.vanVelthoven& PeltierA, LagunaMRetal. Laparoscopicextraperitoneal adenomectomy (Millin):pilot study on feasibility. Eur Urol2004;45:L03-L09.Nadler Robert B, Blunt Lynn W Jr., User Herbert M, Vallancien G. Preperitoneal laparoscopic sim-ple prostatectomy. Urology 2004; 63:778.e9-778e'1,0.Sotelo R, Spaliviero M, Garcia-Segui A, et al. Laparoscopic retropubic simple prostatectomy. J Urol2005;173:757-760.Sotelo R, Garcia A, Hanssen A, et al. Prostatectomia Radical Laparosc6pica: Reporte de los primeros20 casos. Urol Panam Ene-Mar 2003; 15(1):4246.Njinou Ngninkeu B, Gaston & Piechaud I Lorge F. Laparoscopic prostatic adenomectomy assistedby index digital finger: a preliminary report. J Endourol 2003;L7(suppl 1);Abstract MP19.28.

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