some authors suggested the "anteroposterior approach" rather than retrograde approach
I assume that anteroposterior approach is a bit challenging in a large prostate as the plane between the adenoma and the capsule is easier to find posteriorly, where the major bulk of the adenoma is located, than anteriorly?!!
I can differentiate prostate Capsule fiber from prostate gland in any approach, retrograde or anterior-posterior.
I think that the most important step in enucleation even for experienced surgeons, is to mark the distal end of enucleation proximal to the anatomic landmark vero, and at the vero turn the scope anterioly to mark the territory there as well. That way even if the field becomes bloody safety margins are respected throughout the operation.
The jury is out on this one.
There are no data that proves that any approach is better than the others. Most likely it should be not the approach, but the amount of tension you put into the prostate separation from the neck.
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