Hellow guys, Welcome to my website, and you are watching SA-1 transperitoneal laparoscopic radical prostatectomy ( Serdar AYKAN, MD ). and this vIdeo is uploaded by SERDAR AYKAN at 2018-11-16T15:14:05-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | SA-1 transperitoneal laparoscopic radical prostatectomy ( Serdar AYKAN, MD ) |
| Video Uploader | Video From SERDAR AYKAN |
| Upload Date | This Video Uploaded At 16-11-2018 23:14:05 |
| Video Discription | LAPAROSCOPIC TRANSPERITONEAL RADICAL PROSTATECTOMY Purpose: Laparoscopic radical prostatectomy (LRP), which is a minimally invasive treatment, now takes place in organ-confined prostate cancer treatment. This reliable technique; allowing the pelvic anatomy to be displayed endoscopically in a perfect manner, a good dissection of the prostate, and a proper reconstruction of the urinary tract. The main aim at LRP, besides radical control of cancer, is to preserve continence, erectile function and the quality of patients’ life, likewise in open surgery. Debate still continues about transperitoneal and extraperitoneal approaches in which is superior to one another. In this video-poster, we presented our transperitoneal laparoscopic descending radical prostatectomy technique which is a standart procedure in Haydarpasa Numune SUAM Urology Clinic. Case: 65 year old male patient was admitted to our outpatient clinic with frequent and difficult voiding. Mean voiding rate was 12ml/sec and total voided volume was 250cc in uroflowmetric study. Residual urine volume was 50cc. In ultrasonography, prostate volume was calculated as 42cc. PSA was 7,3. In physical examination, external genitalia was normal and digital rectal examination was palpated as grade 1 benign. As evaluated with these results, ultrasound guided transrectal prostate biopsy was done. The pathology result was adenocarcioma, gleason score (3+3) 6, in 4 out of 12 cores, ISUP grade group 1. IPSS was calculated 19 and IIEF-5 score was calculated 16. The decision about the patient was bilateral nerve sparing radical prostatectomy. Surgical Technique: Patient lay down supine, 30 degrees trandelenburg position with his arms and hand attached to the body on the side. A 10 mm camera port just above the umblicus, one 10 mm and three 5mm trocars were placed as a reverse U position between umblicus and two spina iliaca anterior superiors. After intraperitoneal inspection, urachus and both medial umblical ligaments were incised. This incision was continued until the inguinal canal border. Dissection of the Retzius at the prepubic area leads to the pubic bone. The anterior of the bladder was completely freed by the dissection of the perivesical tissues. The fatty tissue over the anterior prostate and endopelvic fascias were resected using LigaSure (Medtronic). Endopelvic fascia was incised laterally to the prostate bilaterally and this incision was extended until puboprostatic ligament anteromedially. Then, the levator ani fibres were dissected from the lateral wall of prostate. After the incision of the puboprostatic ligaments, distally to the prostatic apex, Santorini plexus was coagulated twice with 5mm LigaSure, but not cut. Subsequently, bladder neck was incised with Harmonic scalpel (Ethicon). After incising anteriorly, prostate was hung up by the help of the Foley catheter. The posterior wall of the bladder neck was incised to reach the ductus deferens and the seminal vesiculas and they were dissected. Denonvillier fascia was descendingly incised and the plan between the prostate and rectum was dissected. Bilateral pedicles were controlled with Hemoloc clips. Bilateral nerve sparing technique was utilised by a precise intrafascial dissection which is very close to prostatic capsule. Deep dorsal vein complex was coagulated again and cut with LigaSure. Urethra was incised and prostatic tissue is removed. Urethrovesical anostomosis was done with the continous suturing technique which is defined by Van Velthoven with two 15cm, 26mm, 3/0 V-Loc™ 90 Device (Covidien) sutures. No peroperative or postoperative complications were seen. Estimated blood loss was 40cc. Total operation time was 130 minutes including the anostomosis time which was 20 minutes. The drain was removed at the 2nd day postoperatively and the patient was discharged on the 3rd day. Foley catheter was removed at 7th day. Early continence will be evaluated at 3rd month control of the patient. Conclusion: Laparoscopic radical prostatectomy is a favorable operation method in terms of the oncological and functional outcomes which can be compared with open surgery series, regarding all the minimal invasive surgery advantages (less blodd loss, less hospitalisation, faster mobilization, better cosmetic results). Optimal anatomical visuals with optical magnification and a good nerve sparing surgical technique enhances the continence and erectile outcomes after surgery which increases the quality of life. |
| Category | People & Blogs |
| Tags | laparoscopy | radical prostatectomy | laparoscopic radical prostatectomy | transperitoneal laparoscopic radical prostatectomy | serdar aykan | urology | prostate cancer | minimally invasive surgery |
