Difficulties in Laparoscopic Simple Prostatectomy

Abstract

Open surgical simple prostatectomy has traditionally been the treatment of choice for symptomatic benign enlargement of the prostate.¹ In 1894, Eugene Fuller performed a series of suprapubic prostatic adenomectomies in New York city. Eleven years later, he published an investigative work entitled “The question of priority in the adoption of the method of total enucleation suprapubically of the hypertrophied prostate.”² However, it was not until 1912 that, thanks to the results obtained by Peter Freyer, this approach was popularized using a technique consisting of enucleation of the prostatic adenoma through an extraperitoneal incision in the wall of the bladder. This surgical technique did not change until 30 years later when Terence Millin described his technique for a retropubic simple prostatectomy in 1945. Millin developed the innovative trans-capsular approach, which spared the bladder from unnecessary incisions. This avoided the morbidity and complications associated with the vesicotomy.³