Transcapsular adenamectomy(Millin): A comparative study, extraperitoneal laparascopy versus open surgery

Objective: To demonstrate the safety of the Millin extraperitoneal laparoscopic adenomectomy by comparing the laparoscopic and open approaches. Methods: From January 2003 to April 2005, patients, with indication of prostatic adenomectomy, were offered the chance to choose between 2 types of procedure: Millin adenomectomy with open or extraperitoneal laparoscopic approach. Forty patients were included in this prospective non-randomised study. The patients were divided into 2 Groups. Group A (20 patients) underwent extraperitoneal laparoscopic adenomectomy, while Group B (20 patients) was treated by open surgery. Pre-operative, peri-operative and post-operative parameters were evaluated. Group A was subdivided in two sub-groups (first ten and last ten) and perioperative parameters were considered in order to determine the learning curve. Results: In terms of pre-operative parameters considered, the 2 study groups are comparable (p > 0.3). As far as peri and post-operative parameters are concerned: mean blood loss for Group A was 411.6 +/- 1419 ml, for Group B 687.5 +/- 298.6 ml (p = 0.004). For all the other parameters no significant statistical differences were recorded (p > 0.4). Mean operative time was 107.2 +/- 34.9 min in Group A, and 95.5 +/- 22.5 min in Group B. Mean adenoma weight in Group A was: 69,5 +/- 21.5 g, in Group B: 88.1 +/- 43.8 g. Mean haemoglobin levels in Group A was: 11.2 +/- 1.8 g/dI, Group B: 11.6 +/- 1.2 (10-13.4) g/dl. Mean Analgesic consuming (Tramadol) during the post-operative stay was 385 36 mg in Group A, versus 430 108 mg in Group B. Mean catheterization time was 6.3 +/- 3.7 days in Group A, 5.6 +/- 1.1 days in Group B. The mean hospital stay was 7.8 +/- 4.1 days in Group A, and 7 +/- 1.6 days in Group B. One patient (5%) from Group A was re-operated for bleeding and clot retention, whilst in Group B patients did not present complications which required any further intervention. As far as peri-operative and post-operative parameters of the two sub-Groups A (first ten patients and last ten patients) are concerned, the statistical evaluation shows a significant difference only on operative time (p = 0.01). The p-value for the other parameters was not significant (p > 0.1). Conclusions: The extraperitoneal laparoscopic adenomectomy is a safe technique presenting results comparable to open surgery with the advantage of significantly lower peri-operative blood loss. (c) 2005 Elsevier B.V. All rights reserved.