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Radical Laparoscopic Prostatectomy: Managing Localized Prostate Cancer Chase Wilson M1
Patient Presentation Difficulty urinating Decreased force of urine flow Blood in urine and/or semen Swelling in legs Pelvic pain
Clinical Screening Digital Rectal Exam (DRE) Abnormal size/texture of prostate PSA > 4.0 ng/mL
Diagnostic Tools and Stages of Prostate Cancer Ultrasound Prostate biopsy (Gleason score) CT Scan MRI Stage I—not detectable on DRE Stage II—detectable on DRE, confined to prostate Stage III—spread to seminal vesicles/nearby tissues Stage IV—complete metastasis
Non-Surgical Treatment Options Radiation Therapy External radiation Brachytherapy (radioactive seeds) Hormone therapy (decrease testosterone levels) Medications Orchiectomy Chemotherapy
Surgical Treatment Options Retropubic Surgery Perineal Surgery Laparoscopic Surgery Robotic Surgery
Advantages of Laparoscopic Approach Better visualization of prostate anatomy Reduced blood loss Better nerve sparing Quicker post-operative recovery
Laparoscopic Prostatecomy: Operating Room Layout Surgeon Patient in 30° Trendelenburg Assistants Video monitors
Standard Laparoscopic Instruments 0° Laparoscope Fine dissecting scissors Ultrasonic dissectors Fine grasping forceps Needle holder Suction-irrigation device Retrieval bag Grasping urinary catheter 2.0 braided suture, 26 mm needle 3.0 absorbable, monofilament suture, 26 mm needle
Trocar Placement A: Below umbilicus B: 2 cm medial to ASIS C: Between A & B D: Midline, between umbilicus and pubic symphysis E: 2 cm medial to ASIS
Instrument Placement Laparoscope Grasper/s uction Grasper/suction, scissors Ultrasonic scissors, needle holder Forceps, grasper
Prostatectomy Procedure 1 Detach bladder from anterior abdominal wall (D1_:12) Detach bladder from anterior abdominal wall (D1_:12) 2 Anterior and lateral dissection of prostate (:16-40) Anterior and lateral dissection of prostate (:16-40) 3 Divide prostate and bladder neck (D2_:02-08) Divide prostate and bladder neck (D2_:02-08) 4 Dissection of ductus deferens and seminal vesicles (:12) Dissection of ductus deferens and seminal vesicles (:12) 5 Incise Denovillier’s fascia, dissect prostate from rectum (:22) Incise Denovillier’s fascia, dissect prostate from rectum (:22)
Prostatectomy Procedure 6 Carefully dissect neurovascular bundles from lateral prostate (:28) Carefully dissect neurovascular bundles from lateral prostate (:28) 7 Hemostasis and division of superficial dorsal vein (:46) Hemostasis and division of superficial dorsal vein (:46) 8 Divide prostate and urethra (:52) Divide prostate and urethra (:52) 9 Remove prostate, seminal vesicles, and ductus deferens (:57) Remove prostate, seminal vesicles, and ductus deferens (:57) 10 Vesicourethral anastomosis (D3) Vesicourethral anastomosis (D3)
Detach Bladder Anterior abdominal wall Bladder Future Retzius’ space
Anterior/Lateral Dissection Pelvic rim Prostate Location of superficial dorsal vein (Inside Retzius’s space)
Superficial Dorsal Vein Superficial dorsal vein Prostate Pelvic rim Pelvic floor (levator ani and endopelvic fascia) Location of nerve bundle
Divide Prostate and Bladder Neck Superior prostate Urinary catheter Bladder neck
Seminal Vesicles/Ductus Deferens Location of neurovascular bundle Ductus deferens Seminal vesicle
Denovillier’s Fascia Seminal vesicle Denovillier’s fascia Neurovascular bundle Rectum (deep to denovillier’s fascia) Posterior prostate
Nerve Sparing Neurovascular bundle Fine dissecting scissors Plexus of nerves Scissors dissect between prostatic capsule and lateral prostatic fascia
Division of Superficial Dorsal Vein Superficial dorsal vein Anterior prostate
Division of Prostate and Urethra Urethra Catheter Prostate
Prostate Removal Pelvic rim Lateral prostate Superior prostate
Vesicourethral Anastomosis Urethra Catheter w/ grasper Anchor stitch Needle holder Bladder neck
Time Lapse Anastomosis Urethra Bladder neck
Post-Operative Care Infection control: Antibiotics Drain Urinary catheter (removed ~7 days post-op) Blood thinners Little pain medication necessary
Operative Complications Infection Incontinence Erectile dysfunction Persistent cancer Blood clots
References Images and Procedure: Dr. Strup’s Radical Laparoscopic Prostatectomy Teaching DVD Background information: Piechaud T, Saussine C. Laparoscopic radical prostatectomy: transperitoneal approach. Epublication: WeBSurg.com, Feb 2006; 6(2). URL: http://www.websurg.com/ref/doi- ot02en302.htmhttp://www.websurg.com/ref/doi- ot02en302.htm
Total Laparoscopic Hysterectomy Andrew Doering Minimally Invasive Surgery Lab University of Kentucky.
NEW OPTIONS IN PROSTATE CANCER TREATMENT Presented by Triangle Urology Associates, P.A.
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Prostate Cancer Treatment: What’s Best For You? Rajesh G. Laungani, MD Director, Robotic Urology Chairman, Prostate Cancer Center Saint Joseph’s Hospital,
Prostate Cancer Education Seminar. What is the Prostate? A male sex gland The size of a walnut below the bladder and in front of the rectum Produces the.
HELIOS Kliniken Leipziger Land Folie: 1 K. Kuhnt D. Schulz NESA DAYS 2006 Positive margins and early postop potency after Nerve-sparing ELRP Kai Kuhnt.
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Carcinoma of the Prostate By: Ishan Parikh. Background on Cancer Oldest information dates back to 3000 BC, Egyptian textbook on trauma surgery – “There.
Focus on Prostate Cancer (Relates to Chapter 55, “Nursing Management: Male Reproductive Problems,” in the textbook) Copyright © 2011, 2007 by Mosby, Inc.,
بسم الله الرحمن الرحيم IN THE NAME OF ALLAH THE MOST GRACEFUL THE MOST MERCIFUL.
Frequent urge to urinate Blood in urine or semen Painful or burning urination Difficulty urinating Difficulty having an erection.
Marshall-Marchetti-Krantz (MMK). What is it? Performed to correct stress incontinence in women. a common result of childbirth and/or menopause. Incontinence.
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Dr. Nimir Dr. Safaa Dr Rania Gabr Discuss the site, size, shape and relation of prostate. Describe the fasciae covering and related to the prostate (true.
The pelvis and perineum The pelvis and perineum. Introduction pelvis — bony pelvis pelvic walls pelvic diaphragm pelvic organs blood vessels and nerves.
David Spellberg, MD, FACS Naples Urology Associates.
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PROSTATE CANCER Dr Samad Zare Assistant Proffesor of Urology Shaheed Sadoughi University of Medical Sciences.
50 Vs 50 A Comparison of the Oncologic Outcomes of Retropubic Prostatectomy and Robotic Prostatectomy Chris Ogden Tim Christmas Jordan Durrant Khalid A.
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CA of Prostate:Incidence In a 50 y/o man In a 50 y/o man In autopsy: 40% In autopsy: 40% Clinical: 10% Clinical: 10% Death: 3% Death: 3% Most common non-cutanous.
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Prostate Cancer Foundation of Australia Ambassador Presentation Prostate Health 2007.
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