Most penile revascularization techniques use the inferior epigastric artery as the donor vessel for anastomosis to the dorsal penile artery. Traditionally, the inferior epigastric artery is harvested using a midline or paramedian incision. We present a minimally invasive approach to the mobilization of inferior epigastric artery, obviating the need for a large incision and its associated postoperative pain, slower recovery and wound complications. A preoperative angiogram is essential to determine which side epigastric vessel will be used, based on patency and level of bifurcation. We use a 10 mm balloon trocar below the umblicus to achieve preperitoneal insufflation. Two 5 mm trocars are then placed on the contralateral side, lateral to the inferior epigastric artery on that side. The inferior epigastric artery is identified at its origin from the external iliac artery, and the dissection is carried caudad to cephalad, to the point of bifurcation near the umblicus. No attempt is made to separate the artery from the accompanying vein to avoid injury to the artery. Once the inferior epigastric bundle is clipped and divided, a small transverse incision is made at the penile base. A 10 mm dilating trocar is placed through the Hesselbach's triangle through this incision, and the epigastric bundle is delivered to the penile base through the trocar sheath under direct visualization to prevent torsion. The microvascular anastomosis is then carried out by the urologists through this infrapubic incision.

We have performed this procedure in 6 patients between 2000 and 2004 with good outcomes. This approach is an example of innovative, albeit unusual, application of minimally invasive surgery with its inherent advantages of improved cosmesis, shorter recovery and decreased morbidity, without compromising the efficacy of the procedure.