28
S Radical Laparoscopic Prostatectomy: Managing Localized Prostate Cancer Chase Wilson M1

Radical Laparoscopic Prostatectomy:

  • Upload
    elia

  • View
    66

  • Download
    2

Embed Size (px)

DESCRIPTION

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) - PowerPoint PPT Presentation

Citation preview

Page 1: Radical Laparoscopic Prostatectomy:

S

Radical Laparoscopic Prostatectomy:

Managing Localized Prostate Cancer

Chase Wilson M1

Page 2: Radical Laparoscopic Prostatectomy:

Patient Presentation

Difficulty urinating Decreased force of urine flow Blood in urine and/or semen Swelling in legs Pelvic pain

Page 3: Radical Laparoscopic Prostatectomy:

Clinical Screening

Digital Rectal Exam (DRE) Abnormal size/texture of prostate

PSA > 4.0 ng/mL

Page 4: Radical Laparoscopic Prostatectomy:

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

Page 5: Radical Laparoscopic Prostatectomy:

Non-Surgical Treatment Options

Radiation Therapy External radiation Brachytherapy (radioactive seeds)

Hormone therapy (decrease testosterone levels) Medications Orchiectomy

Chemotherapy

Page 6: Radical Laparoscopic Prostatectomy:

Surgical Treatment Options

Retropubic Surgery Perineal Surgery Laparoscopic Surgery Robotic Surgery

Page 7: Radical Laparoscopic Prostatectomy:

Advantages of Laparoscopic Approach

Better visualization of prostate anatomy Reduced blood loss Better nerve sparing Quicker post-operative recovery

Page 8: Radical Laparoscopic Prostatectomy:

Laparoscopic Prostatecomy: Operating

Room Layout

Surgeon

Patient in 30° Trendelenburg

Assistants

Video monitors

Page 9: Radical Laparoscopic Prostatectomy:

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

Page 10: Radical Laparoscopic Prostatectomy:

Trocar PlacementA: 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

Page 11: Radical Laparoscopic Prostatectomy:

Instrument PlacementLaparoscope

Grasper/suction

Grasper/suction, scissors

Ultrasonic scissors, needle holder

Forceps, grasper

Page 12: Radical Laparoscopic Prostatectomy:

Prostatectomy Procedure

1 Detach bladder from anterior abdominal wall (D1_:12)

2 Anterior and lateral dissection of prostate (:16-40)3 Divide prostate and bladder neck (D2_:02-08)4 Dissection of ductus deferens and seminal vesicles

(:12)5 Incise Denovillier’s

fascia, dissect prostate from rectum (:22)

Page 13: Radical Laparoscopic Prostatectomy:

Prostatectomy Procedure

6 Carefully dissect neurovascular bundles from lateral prostate (:28)

7 Hemostasis and division of superficial dorsal vein (:46)8 Divide prostate and urethra (:52)9 Remove prostate, seminal vesicles, and ductus deferen

s (:57)10 Vesicourethral anastomosis (D3)

Page 14: Radical Laparoscopic Prostatectomy:

Detach BladderAnterior

abdominal wall Bladd

er

Future Retzius’ space

Page 15: Radical Laparoscopic Prostatectomy:

Anterior/Lateral Dissection

Pelvic rim

Prostate

Location of superficial dorsal vein

(Inside Retzius’s space)

Page 16: Radical Laparoscopic Prostatectomy:

Superficial Dorsal Vein

Superficial dorsal vein

Prostate

Pelvic rim

Pelvic floor (levator ani and endopelvic fascia)

Location of nerve bundle

Page 17: Radical Laparoscopic Prostatectomy:

Divide Prostate and Bladder Neck

Superior prostate

Urinary catheter

Bladder neck

Page 18: Radical Laparoscopic Prostatectomy:

Seminal Vesicles/Ductus Deferens

Location of neurovascular bundle

Ductus deferens

Seminal

vesicle

Page 19: Radical Laparoscopic Prostatectomy:

Denovillier’s FasciaSemin

al vesicl

e

Denovillier’s fascia

Neurovascular bundle

Rectum (deep to

denovillier’s fascia)

Posterior prostate

Page 20: Radical Laparoscopic Prostatectomy:

Nerve Sparing

Neurovascular bundle

Fine dissectin

g scissors

Plexus of nerves

Scissors dissect between prostatic capsule and lateral prostatic fascia

Page 21: Radical Laparoscopic Prostatectomy:

Division of Superficial Dorsal Vein

Superficial dorsal vein

Anterior prostate

Page 22: Radical Laparoscopic Prostatectomy:

Division of Prostate and Urethra

Urethra

Catheter

Prostate

Page 23: Radical Laparoscopic Prostatectomy:

Prostate Removal

Pelvic rim

Lateral prostate

Superior

prostate

Page 24: Radical Laparoscopic Prostatectomy:

Vesicourethral Anastomosis

Urethra

Catheter w/

grasper

Anchor stitch

Needle holder

Bladder neck

Page 25: Radical Laparoscopic Prostatectomy:

Time Lapse Anastomosis

Urethra

Bladder neck

Page 26: Radical Laparoscopic Prostatectomy:

Post-Operative Care

Infection control: Antibiotics Drain

Urinary catheter (removed ~7 days post-op) Blood thinners Little pain medication necessary

Page 27: Radical Laparoscopic Prostatectomy:

Operative Complications

Infection Incontinence Erectile dysfunction Persistent cancer Blood clots

Page 28: Radical Laparoscopic Prostatectomy:

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.htm