V1243: LAPAROSCOPIC RESOLUTION OF COMPLICATIONS DURING RADICAL PROSTATECTOMY
VideoIntroduction and Objectives
Since its introduction, Laparoscopic preperitoneal radical prostatectomy (LPPRP) is undergoing continuous refinements which make it today a feasible, reproducible, and teachable operation. Nevertheless intraoperative complications require often conversion to open surgery. The video shows a laparoscopic resolution of a rectal injury and of an external iliac vein lesion during preperitoneal radical prostatectomy.
After creating the preperitoneal space by balloon trocar dissection, five trocars (2 x 5mm and 3 x 10mm port) are placed in the hypogastrium. Bilateral pelvic lymphadenectomy is performed. Bilateral incision of endopelvic fascia anticipates haemostatic transacted suture of Santorini plexus with Vicryl™. Bladder neck dissection. Urethra is then transected. Vas deferens are isolated and then cutted; mobilization of seminal vesicles precedes incision of the Denonvilliers' fascia. Section of the prostatic pedicles is routinely realized with Ligasure™ or with Hem-O-lock and endoshears, when a nerve sparing technique is performed. Because of strong adhesion between prostate and rectum an injury of the anterior rectal wall occurs. After cutting Santorini plexus and urethra, the prostate is placed in endobag. The rectal lesion is repaired with Vicryl™ sutures. A sponge of Tachosil™ is applied on the repaired rectal wall using a laparoscopic dedicated device. In the second case the video shows a lesion of right external iliac vein occurred during removal of a needle from abdominal cavity. The vein is isolated and clamped by a self made tourniquet. The lesion is repaired with a Prolene suture. A Surgicel™ sheet is applied on the vein. Bladder neck biopsy and water-tight urethrovesical anastomosis with double running suture as described by van Velthoven are performed.
In both cases the laparoscopic surgical procedure is realized without any major consequences.
The LPPRP is feasible and reproducible technique that could be subject to intraopeative complications requiring conversion to open surgery. Nevertheless it is possible resolve, also during learning curve, major complications as rectal and vascular injuries without conversion to open surgery.