V3-05: Single-Port Extraperitoneal Laparoscopic Harvest of Inferior Epigastric Artery for Penile Revascularization
The harvest of inferior epigastric artery (IEA) for penile revascularization has been traditionally performed through an open transverse abdominal incision. Laparoscopic approaches have been described with some efficacy. Herein, we describe a single-port extraperitoneal laparoscopic approach to harvesting the IEA for penile revascularization in patients with erectile dysfunction due to focal arterial blockage. To our knowledge, this is the first report of such an approach and may help minimize patient morbidity while providing a better cosmetic result.
We describe this procedure in a 29 year old healthy male with history of pelvic trauma at age 27 years. Penile doppler ultrasound demonstrated right cavernosal artery insufficiency. First, we isolated the dorsal penile artery by a vertical midline penoscrotal incision. We proceeded to harvesting the IEA by making a small curvilinear incision under the umbilicus. Rectus muscle was separated, posterior sheath was identified, and blunt dissection was carried out in the extraperitoneal space, which was developed using a balloon insufflator. The mini gel port was placed with three trocars. IEA was bluntly dissected and branches were clipped. The IEA was clipped and cut proximally. A trocar was inserted through the external inguinal canal to deliver the artery from the extraperitoneal space to the penoscrotal incision. The anastomosis of the IEA to the dorsal artery was carried out microscopically.
Operative time was 4.5 hours. Estimated blood loss was 20 cc. Patient was discharged on postoperative day one. Harvest of IEA through the single-port extraperitoneal laparoscopic approach and subsequent microscopic anastomosis to the dorsal penile artery was carried out successfully.
Single-port extraperitoneal laparoscopic harvest of IEA for penile revascularization is safe, feasible, and may help minimize patient morbidity.