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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: ot02en302.htmhttp://www.websurg.com/ref/doi- ot02en302.htm
Total Laparoscopic Hysterectomy Andrew Doering Minimally Invasive Surgery Lab University of Kentucky.
PROSTATE CANCER Dr.GOVINDRAJAN Department of Urology & Renal Transplantation SRMC & RI.
Inguinal Hernia Laparoscopic repair Sakib Motalib University of Kentucky College of Medicine, M1.
New Developments In The Management of Prostate Cancer Dr. Manish Patel Urological Cancer Surgeon Westmead Public and Private Hospital Westmead Public and.
1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 48 Male Reproductive Disorders.
Advances in MR Imaging of PROSTATE CANCER Demetri Papadatos, MD, FRCPC Abdominal Imaging Radiologist Director, Abdominal Imaging Fellowship Director, Percutaneous.
Yehya Elshebiny Adan Hospital. Bladder. Urethra. Genital.
Prostate Cancer What a GP Needs to Know Dr Manish Patel Urological Cancer Surgeon Sydney Adventist Hospital Sydney Adventist Hospital Westmead Public and.
Investigation and Management of Prostate Cancer Mr C Dawson MS FRCS Consultant Urologist Edith Cavell Hospital, Peterborough.
PROSTATE TUMORS DEPARTMENT OF UROLOGY IAŞI – 2013.
Right Laparoscopic Adrenalectomy University of Kentucky Minimally Invasive Surgery Elective.
SACROSPINOUS FIXATION 1 Dr Mona Shroff
© 2008 Delmar Cengage Learning. CHAPTER 20 Genitourinary Surgery.
Subcutaneous (C), superficial (B), deep (A) The rectum and anal canal are supplied by the superior rectal artery (the continuation of the inferior.
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INGUINAL HERNIA REPAIR: OPEN vs TEP APPROACHES Prof Dr Orhan Alimoğlu Department of General Surgery Istanbul Medeniyet University.
Warm up Take notes by filling in the blanks Male Reproductive System TESTES and EPIDIDYMIS –Testes produce male gametes sperm (SPERMATOZOA) and male.
The Urinary System Chapter 18 9/9/10 Classroom ed.
Laparoscopic Nephrectomy Dr. SUNIL SHROFF Prof.Urology & Renal Transplantation Sri Ramachandra Medical College & Research Institute (
By. Dr. Mujahid Khan. It is a triangular musculofascial diaphragm Situated in the anterior part of the perineum Filling in the gap of the pubic.
A 3D U LTRASOUND-BASED T RACKING S YSTEM FOR P ROSTATE B IOPSY D ISTRIBUTION Q UALITY I NSURANCE AND G UIDANCE. PhD Thesis Michael Baumann Supervisors.
To Do Or Not To Do (about the hysterectomy) Dr Muhammad El Hennawy Ob/gyn specialist Rass el barr - Dumyat – Egypt Mobile
Urology overview SRMC – Jan 2000 Dr. SUNIL SHROFF Prof.Urology & Renal Transplantation Sri Ramachandra Medical College & Research Institute.
Financial Disclosure As it pertains to CME, I have no relevant financial relationships with any commercial interest to disclose. Minimally Invasive Surgery.
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