Laparoscopically assisted penile microsurgical revascularization

Microsurgical revascularization of the penis in vasculogenic impotence is an accepted surgical procedure. Most of the early types of penile revascularization use the inferior epigastric artery. In order to avoiding the wide pararectal incision, Lund has recently proposed the laparoscopic mobilization of the inferior epigastric vessels. Herein we present three consecutive cases of successful laparoscopically assisted penile revascularization. With the patient under general anaesthesia, the first trocar was inserted in the umbilical region through an Hasson incision and pneumoperitoneum was induced. Other 2 trocars were placed at the right side of patient's abdomen rather laterally. As soon as the access to the inferior epigastric vessels was gained, dissection was initiated on the left inferior epigastric artery below the arcuate line level. The vessels were dissected cephalad en bloc to a bifurcation point of the inferior epigastric artery above the umbilical level, avoiding unnecessary separation of the artery from its accompanying veins. The left inferior epigastric pedicle was ligated by clips and transected at the cephalic margin of the dissection; then it was mobilized and tunnelled through an infrapubic incision at the base of the penis for subsequent microvascular anastomosis with the penile vessels. Ideal candidates for this kind of surgery are young men with no significant vascular risk factors and whose impotence can be referred to a pelvic bones fracture or blunt perineal trauma. We have verified the possibility of mobilizing the inferior epigastric artery through a laparoscopic approach, thus avoiding a long abdominal incision and transection of the reclus muscle. Advantages of this approach consist in a significant reduction of postoperative morbidity, pain, scarring and convalescence. Our experience confirms the considerably practical use of laparoscopy which, due to its magnification, allows to perform a fast and very accurate excision of the epigastric bundle from the origin at the external iliac vessels to a cephaled point.