Laparoscopic radical prostatectomy by extraperitoneal access with duplication of the open technique

Abstract

Introduction: The laparoscopic radical prostatectomy is a continually developing technique. Transperitoneal access has been preferred by the majority of centers that employ this technique. Endoscopic extraperitoneal access is used by a few groups, nevertheless it is currently receiving a higher acceptance. In general, the antegrade technique is used, with dissection from the bladder neck to the prostate apex.The objective of the present paper is to describe the extraperitoneal technique with reproduction of the open surgery's surgical steps.Surgical Technique: With this technique, the dissection of the prostate apex is performed and, following the section of the urethra while preserving the sphincteric apparatus, the Foley catheter is externally tied and internally recovered, which allows cranial traction, similarly to the way it is performed in conventional surgery. The retroprostatic space is posteriorly dissected and the seminal vesicles are identified by anterior and posterior approach, obtaining with this method an optimal exposure of the posterolateral pedicles and the prostate contour. The initial impression is that this technique does not present higher bleeding rate or difficulty level when compared with antegrade surgery. Potential advantages of this technique would be the greater familiarity with surgical steps, isolated extraperitoneal drainage of urine and secretions and a good definition of prostate limits and lateral pedicles, which are critical factors for preserving the neurovascular bundles and avoiding positive surgical margins. A higher number of cases and a long-term follow-up will demonstrate its actual value as a technical option for endoscopic access to the prostate.

The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy

“…Recently, some studies have reported the safety of using the Hem-o-lok clip for the closure of appendicular stump [6-9]. Additionally, the safety of using Hem-o-lok clips for the ligation of vessels, ureters, and bile ducts has been documented in over 1,000 surgical procedures [12-14]. …”

Hem-o-lok plastic clips in securing of the base of the appendix during laparoscopic appendectomy

“…The use of hem-o-lok clips, which are nonabsorbable, polymer structures for ligation of vessels, ureters, and bile ducts, has been documented in over 1,000 surgical procedures [7][8][9][10].…”

Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

“…The adopted surgical technique was performed through 5 ports, through extraperitoneal space, practically duplicating all steps used in conventional open radical prostatectomy (7). All patients received prophylaxis for venous thrombosis with low molecular weight heparin up to 48 hours following surgery and mobilization in bed after the first 24 hours.…”