Laparoscopic simple prostatectomy, a lost child of laparoscopic surgery

Benign prostatic hyperplasia (BPH) requiring surgery has become a significant public health challenge in recent times as a result of the increase in population longevity. Furthermore, most of these patients have associated comorbidities and treatments, particularly with antiplatelet and anticoagulant drugs causing limitations in the surgical options such as open simple prostatectomy, or even transurethral procedures, which already have high complication rates. Open prostatectomy has been historically regarded as the treatment of choice for large glands and has been considered the most invasive; however, it has also been the most effective and durable procedure for the treatment of BPH. Laser treatment was previously regarded as an alternative to transurethral resection of the prostate, but nowadays the upper limit of transurethral resection has evolved and increased during the last couple years due to an evolution in laser technology, the different systems produce different qualitative and quantitative effects in tissue, such as coagulation, vaporization, or resection and enucleation via incision. The goal is to achieve similar efficacy parameters, with the same improvements in symptoms and quality of life, but with less morbidity and shorter hospitalisation time. Recent studies have shown that holmium laser enucleation leads to similar outcomes when compared to open prostatectomy in men with large glands, at a significantly lower complication rate [1, 2]. These findings and the advantages of being an endoscopic procedure, have helped laser techniques achieve a place within the field of urology. However, holmium laser enucleation is a surgical procedure that requires experience and relevant endoscopic skills which result in a lengthier learning curve. The advent of laparoscopy and robotics in urology is an area that has tremendous potential. Laparoscopic simple prostatectomy, either from the inside of the bladder (Freyer procedure) or through the anLaparoscopic simple prostatectomy, a lost child of laparoscopic surgery