Role of Benique in Single Incision Laparoscopic Prostatectomy. Our Experience
Laparoscopic prostatectomy is a well-established and standardized technique to treat patients with localized prostate cancer. Nevertheless, the procedure is continuously in evolution in order to yield better results in cosmesis, pain , convalescence and in order to reduce the risk of the technique manteining the benefits in terms of potency, continence and oncological management.
Aim of this study is to show how the Benique aided single incision laparoscopic prostatectomy (SILP) technique with totally extraperitoneal approach can avoid the ligation of Santorini dorsal venous complex
Materials and Methods
retrospective study on 262 SILP in the period 2011-2015 : match analysis between surgical and transfusional data
Benique catheter is applied along the urethra after the bladder neck incision allowing : 1) better exposure and mobilization of the prostate during the seminal vesicles plan dissection and endopelvic fascia and puboprostatic ligaments incision; 2) better Santorini plexus exposure and , after Santorini cold cutting by scissors , 3) no stithces to close it; 4) Santorini compression against the pubis bone to avoid bleeding 5) better urethra exposure during the vesico-urethral suture
262 patients range of age 45 – 76, submitted to SILP from 2011 to 2015, 19 pat (7,2 %) needed
blood transfusions during hospitalization but only 8 pat (3 %) within the early 12 hours after surgery ,
6 patients had a retropubic hematoma, but no treatment was necessary.
1 paz (0,3%) needed rehospitalization for concomitant hematuria occurring 10 days after discharge
Mean surgery time was 100 minutes , range 75 – 130 minutes
No differences in intra-and / or post-operatively blood loss evidenced in the percentage of patients with hemotransfusion were shown with literature : in fact a systematic review of the literature shows that the weighted mean intra and postoperative transfsion rate for laparoscopic prostatectomy is 6,3 % . This shows the security of the technique
even with the single port approach: furthermore the use of Beniquet may be useful both for hemostatic compression and for the exposure of the urethra during vesico-urethral suture
The ligation of Santorini venous plexus is not necessary during laparoscopic prostatectomy : bleeding can be avoided by the use of a Benique catheter for compression .
This save time without increasing risk of important bleeding; the technique is not influenced performing the single incision procedure
De Carlo F., Celestino F., Verri C., Masedu F., Liberati E., Di Stasi S.M. Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: Surgical, Oncological, and Functional Outcomes: A Systematic Review . Urol Int 2014;93:373-383Argomenti: cancro della prostata