LAPAROSCOPY-ASSISTED PENILE REVASCULARIZATION - A NEW METHOD

Analysis of more than 100 penile revascularizations using the Mannheim modification showed a success rate as high as 82% in properly selecte d patients, However, the dissection of the epigastric artery requires a relatively large incision, with the risk of postoperative bleeding, pain, and hernia formation, Therefore, we designed a laparoscopic appr oach for dissection of the epigastric vessels, From January 1995 to Oc tober 1996, we performed laparoscopy-assisted penile revascularization in 15 pharmacotesting nonresponders with erectile dysfunction, The fi rst step is dissection of the penile vessels to minimize the occlusion time of the epigastric arteries, Thereafter, the extraperitoneal cavi ty is exposed using a balloon-trocar system inserted via a 15-mm supra pubic incision, A pneumoextraperitoneum is established, and two furthe r cannulas are inserted (10 mm subumbilical, 5 mm in the lower abdomen contralateral to the desired epigastric artery), The dissection of th e epigastric vessels starts caudally at the origin from the external i liac vessels and continues to the periumbilical area, All branches are dissected between clips, keeping the artery and vein together, For ex traction of the artery, we insert another 5-mm port through the incisi on at the penile base, After desufflation of the extraperitoneal space and closure of the trocar wounds, microsurgical penile revascularizat ion is performed using the previously described modification of the Ha uri procedure, The mean operating time for laparoscopic dissection of epigastric artery was 120 minutes, No intraoperative complication occu rred, One patient suffered from an inguinal hematoma, After a median f ollow-up of 12 month, 53% of patients showed spontaneous erections, an d another 27% achieved a full erection with the aid of additional phar macotherapy. Laparoscopic dissection of the epigastric arteries proved to be feasible, resulting in a considerable reduction of overall morb idity of penile revascularization without reducing the efficacy of the procedure.