V1242: A NOVEL TECHNIQUE TO CONTROL THE DORSAL VEIN COMPLEX DURING ROBOT ASSISTED RADICAL PROSTATECTOMY
VideoIntroduction and Objectives
Suturing and stapling are commonly used techniques to control dorsal vein complex (DVC) during robot assisted radical prostatectomy (RARP) while some authors prefer not to control it. The objective of this video is to describe a novel technique to control DVC during RARP.
Once posterior and lateral dissection is completed, DVC is grabbed with a laparoscopic bulldog clamp prior to apical and urethral dissection. After division of the DVC and the urethra, the bulldog clamp is removed and DVC is controlled with 2/0 polyglactin suture material. This suture was used for periurethral suspension subsequently. In this video, the technique is described in 2 patients.
Until July 2011 this technique was used in 35 patients in our series. Of these patients 19 had undergone concomitant bilateral pelvic lymph node dissection (PLND). Mean age was 63 and EBL was 171 ml. Mean console time was 161 min and 119 min, in patients with or without PLND, respectively. There was no need to increase the intraabdominal pressure during the division of DVC in any patient. No transfusion was needed. No patient had positive surgical margin at the apex. Two patients had positive surgical margin at the posterolateral region (1 pT2, 1 pT3 disease).
The use of laparoscopic bulldog clamp to control DVC enables a clear vision and precise dissection of the apex and the urethra during RARP. This may result with decrease in console time, blood loss and surgical margin positivity at the apex. The technique is easy to perform and feasible.