EERPE

Technique

Fig. 1 ©Mondry,Stolzenburg

The team consists of one surgeon, one assistant and one camera assistant, (Fig 1). After placing the patient in a dorsal supine position, the endopelvic fascia structures are separated bluntly via an incision (approx. 1.5 cm) below the navel. Without opening the abdomen, a balloon trocar is introduced, with which the preperitoneal space is prepared via insufflation, (Fig.2). This space is kept open for the duration of the intervention via a constant supply of CO². Five tubes (working trocars) are introduced into this space, permitting access for 4 instruments and 1 camera, (Fig. 3). If necessary, the pelvic lymph nodes are removed prior to the actual prostatectomy. The intervention itself begins with ligation of the Santorini plexus anterior to the prostate. The remaining steps largely replicate those of the open surgical technique (retropubic descending radical prostatovesiculectomy). Once the prostate has been mobilized from the bladder, the seminal ducts are incised and the seminal vesicles completely mobilized. After incising the Denonvillier fascia (between prostate and rectum), the prostate is mobilised bluntly from the rectum and the lateral prostate pedicles are incised. Depending on the indication, (see Link “Nerve sparing”), the neurovascular bundle, which runs bilaterally in direct proximity to the prostatic capsule, can be pushed away bluntly. After descending the urethral stump, the prostate is initially placed in a retrieval bag and later removed via a trocar port. The technically most challenging stage of the intervention entails joining the bladder neck with the urethral stump using 9 interrupted sutures. In the course of this procedure, a urinary catheter is introduced to secure the link between urethra and bladder (anastomosis), to drain the urine over the following days.