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Radical prostatectomy

Implementation

  • During the operation, the patient lies in the supine position and extreme Trendelenburg position.
  • Five trocar ports are made. The abdominal cavity is inflated.
  • The robot is docked.
  • The peritoneum is opened around the bladder.
  • Lymph nodes are removed if necessary as described under lymph node dissection.
  • Open the endopelvic fascia and divide the puroprostatic ligaments.
  • Incise the neck of the bladder down to the deferens ducts which are divided.
  • Dissect both seminal vesicles which are pulled up.
  • Denonvilliers' fascia is incised and a layer between the rectum and prostate is reached.  
  • Divide side ligaments to the prostate using a nerve-sparing technique if possible.
  • Split the urethra close to the prostate and place in a plastic bag.
  • Anastomosize between the bladder and the urethral stump.
  • Test anastomosis by instilling saltwater into the bladder.
  • The prostate is removed via the umbilical opening.

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