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Robotic Assisted Laparoscopic Radical Prostatectomy

SURGFLIX_RBT 3DMEDIVISION | Republic of Korea Speciality : Robotic Surgery

04:47

Information

Related Information
The radical prostatectomy surgery involves the following:
- The incision for the procedure depends on the type of surgery. During an open surgery,
   the incision is made either in the lower abdomen or the perineum, while laparoscopic
   surgery makes use of small multiple incisions.
- If lymph nodes have to be removed, they may be removed via a lower abdominal
   incision or through the laparoscopic method.
- As the tissues around the prostate are separated, care is taken to prevent bleeding
   from the dorsal venous plexus in front of the prostate.
- The prostate is separated from its surrounding tissue and ligaments.
- The neurovascular bundles are identified. Sometimes, neurovascular bundles on
   both sides are preserved, while in other cases the bundle on one side may
   have to be sacrificed. Preservation of neurovascular bundles may not be necessary
   in older men who already have problems with erection. Similarly, the bundles are not
   preserved if they are also affected by the cancer.
- The seminal vesicles and vas deferens are also separated and removed
- The prostate is cut out along with its urethra, but without disturbing the external
   urethral sphincter. The cut ends of bladder neck and the urethra are
   stitched together.
- A drain is placed in the pelvic region to drain out any fluid that may accumulate. A catheter
   is passed through the urethra to drain urine from the bladder till healing of
   the surgical wound is complete. The procedure can take 2 to 4 hours depending
   on the complexity of the procedure.

Type of Anesthesia
- Radical prostatectomy is done under general anesthesia and sometimes under
   epidural anesthesia.

Approach
Laparoscopic
- Transperitoneal approach
- Extraperitoneal approach (Less pain, Less ileus) ***
- Endoscopic Procedures

Open
- Retropubic approach
- Perineal approach

Indications
- Localized Prostate Cancer without metastasis (when prostate cancer is
   limited to the gland)
- None remarkable surgical risks
- Life expectancy longer than the physical progress of cancer disease(at least 10y)

Warning Signs
- Anastomotic leak
- Clinically significant bleeding
- Clinically significant hematuria

Complications
- Rectal injury
- Other bowel injury
- Ileus
- Bladder injury
- Ureteral injury
- Vascular injury
- Cardiovascular injury
- Wound infection
- Venous thromboembolism (DVT, PE)
- Blood transfusion
- Neuropraxia

Sex
Male

Age
68

Medical Devices

■ Robotic surgical system : Da Vinci Xi

■ Helpful tools :
N/A ENDOWRIST® Permanent Cautery Spatula
N/A ENDOWRIST® ProGrasp™Forceps

■ Action tools :
N/A ENDOWRIST® LargeClipApplier 2
N/A HarmonicACE® Curved Shears 2

■ 3D Recorder : 3DMedivision R-Flix

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