Accurate Control of the Superficial and Deep Dorsal Veins during Radical Retropubic Prostatectomy: The Münster Clamp Technique

Abstract

Objective: To better control the superficial and deep dorsal veins during radical retropubic prostatectomy and, thus, to reduce blood loss. Patients and Methods: A surgical technique is described which introduces a modified Babcock clamp to fully encompass all tissue above the prostatic capsule. In a prospective protocol, 30 consecutive patients (median age 64.5, range 57–76 years) were randomly assigned to either the standard technique or the Münster clamp method. Blood loss was estimated for the entire phase from teasing away the periprostatic fat until the apex had been mobilized. Results: Median hemorrhage was 950 (range 300–2,100) ml for the standard technique and 800 (range 200–1,750) ml for the clamp procedure (Wilcoxon rank sum test, p = 0.17). Conclusions: The Münster clamp technique can reduce hemorrhage during radical retropubic prostatectomy. This method is easy to apply and is also suitable for cystoprostatectomy.

Haemostasis in Urology

“…A modified Babcock clamp has been developed (Munster clamp), which the authors claim significantly reduces haemorrhage during dissection of the deep dorsal veins in radical retro-pubic prostatectomy or cystoprostatectomy. 67 A large needle may also be used to undermine this structure and facilitate en masse ligation, but this may come off later. It is often better to take smaller bites of tissue with running locking sutures in conjunction with piecemeal division of the complex.…”

Spontaneous Priapism after Radical Retropubic Prostatectomy

“…Blood loss was minimal and on each side a Johnson drainage was placed [2] . The postoperative course was uneventful.…”