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Background
Surgical treatment of benign prostatic hyperplasia (BPH) has markedly evolved in the recent years. Minimally invasive treatment is now widespread standard of care. Nevertheless, large prostate volumes continue to pose challenges to the surgeon. Robotic surgery may be useful in such cases. We present a case of a robotic-assisted laparoscopic Millin prostatectomy in a patient with a large prostate.
Case Presentation
A male patient, 73 years old, non-smoker with a past medical history of hypertension, obesity and dyslipidemia. Medicated with lisinopril 5 mg and atorvastatin 20 mg. No history of abdominal surgeries. He presented with an indwelling catheter after an acute urinary retention. He had long-term severe LUTS, mainly voiding symptoms. His IPSS score was 21, with QOL score of 4. The ultrasound showed a prostate volume of 212 cc. Urinalysis was normal.
The patient was proposed robotic assisted laparoscopic Millin prostatectomy. With the patient in dorsal decubitus, we placed a 12 mm port above the umbilicus and we accessed the peritoneal cavity. We placed 2 ports bilateral in the direction of the iliac crests. After dissection and access to the retzius space, the prostate capsule was opened with monopolar energy. Dissection of the prostatic adenoma was carried with preservation of the posterior urethral mucosa. The capsule was closed with a running barbed suture. Total procedure time was 1h. Estimated blood loss was 150 mL. There were no complications after the surgery and the patient was discharged after 3 days, and removed the urinary catheter at the 5th day. Histology revealed BPH. Patient symptoms improved with postoperative Qmax 14 mL/s.
Conclusion
Robotic surgery is a good option for the surgical treatment of BPH, especially in cases with large prostate volumes. It is a minimally invasive technique, which avoids possible urethral trauma that may arise from long endoscopic procedures. As more experience is acquired in urological robotic surgeries by many centers, it is expected this procedure may become more common in BPH treatment.
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