PREOPERATIVE DIAGNOSIS: Adenocarcinoma of the prostate.
POSTOPERATIVE DIAGNOSIS: Adenocarcinoma of the prostate.
OPERATION PERFORMED: Da Vinci nerve-sparing radical retropubic prostatectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 650 mL.
DESCRIPTION OF OPERATION: After adequate general anesthesia had been achieved, the patient was prepped and draped in the dorsal lithotomy position with good padding of all extremities and portions of the body. At this point, five incisions were marked in the abdominal wall for placement of trocars. A small incision was made in the supraumbilical area 2 cm in length. This was cut down to the fascia and a Veress needle was inserted in the pelvis through the peritoneal cavity. Insufflation was begun through the Veress needle.
Once pneumoperitoneum was obtained, then two ports were placed on the right side of the abdomen as well as on the left side of the abdomen. The two on the right included the fourth arm and the right arm. On the left side, one port was placed for the assistant, another port was placed for the left arm, and actually a sixth 5 mm port was placed for the assistant as well. At this point, we then proceeded to place the trocar through the supraumbilical incision and the telescope was inserted into pelvis. No evidence of any significant adhesions was noted, and at this point, all the ports were placed under direct vision with Marcaine infiltration of the skin and fascia.
Once these had all been placed, then the robot was docked, and we proceeded to take down the peritoneum from the anterior abdominal wall and pubis and proceeded to mobilize the prostate. The dorsal venous complex suture was placed of 2-0 Vicryl and another one was placed proximally on the prostate. We then proceeded to cut the endopelvic fascia and mobilize the levator away from the prostate. At this point, we then placed the hook and monopolar on opposing arms on the right and left arms and proceeded to dissect through the prostatovesical junction with cautery dissection and traction. Once we had isolated the Foley catheter in the bladder, this was removed from the bladder and used for traction.
We then proceeded to transect the rest of the prostatovesical junction, identifying the ampulla of the vas and the seminal vesicles. These were cauterized at their bases with care to avoid injury to the neurovascular bundles. The assistant then proceeded to do the nerve-sparing portion of the procedure, and using monopolar hook and bipolar cautery, he was able to create a veil, preserving neurovascular bundle on each side and mobilizing the prostate off the anterior wall of the rectum with care. The urethra was then transected and I proceeded to do the urethrovesical anastomosis with a running 2-0 Monocryl suture, double-armed.
At the end of the procedure, the anastomosis was checked after 24 French 30 mL balloon catheter was placed in the bladder and there were no leaks. We then proceeded to place a drain in the pelvis, Surgicel, and proceeded to release the pneumoperitoneum and close the supraumbilical incision after the prostate was removed in the Endo Catch from the abdomen. A #1 Vicryl suture was placed to close the fascial opening and 4-0 Vicryl was used on the skin, with Steri-Strips. The patient tolerated the procedure well and was transferred to postanesthesia recovery room in good condition. At the end of the procedure, the patient had a well-appearing neurovascular bundle on each side.
