Đang chuẩn bị liên kết để tải về tài liệu:
Endoscopic Extraperitoneal Radical Prostatectomy - part 6

Bắt đầu từ cổ bàng quang một đường rạch song phương sắc nét của fascia phủ bề mặt tuyến tiền liệt được thực hiện distally về phía đỉnh medially dây chằng puboprostatic. Mục tiêu chính là để tạo ra những điểm mốc nơi bóc tách sẽ tiếp tục được thực hiện sau đó trong suốt quá trình. | 92 Chapter 7 J.-U. Stolzenburg R. Rabenalt M. Do E. Liatsikos 7 Starting from the bladder neck a bilateral sharp incision of the superficial fascia overlaying the prostate is performed distally toward the apex medially to the puboprostatic ligaments. The main goal is to create the landmarks where further dissection will be performed later during the procedure. This manoeuvre ascertains preservation of the puboprostatic ligaments. A plane is developed between the prostate and its thin overlaying fascia periprostatic fascia . The principal goal is to develop the right plane and finally detach the prostate from its envelopment leaving intact the puboprostatic ligaments the periprostatic fascia and the endopelvic fascia as a continuous structure. The development of the plane is easier to perform towards the apex as seen in the figure. Technique of EERPE - Step by Step Chapter 7 93 The development of the plane is then continued in an ascending fashion towards the bladder neck. When you are in the right plane you see a shiny surface upon the prostate which is easily detachable from the periprostatic fascia. Dissection and development of the plane between the prostate and the periprostatic fascia can be performed either with the aid of the SonoSurg device or by cold knife incision. When sharp incision is performed vessels should be clipped before cutting. Tip When during the development of the plane at the apex bleeding occurs from the Santorini venous complex you should proceed as follows. The endopelvic fascia is minimally incised and a window is created facilitating the ligation of the Santorini plexus. A 2-0 Polysorb GS-22 needle slightly straightened to facilitate manoeuvrability is then passed under the ligaments and over the Santorini plexus from right to left. The needle is guided from left to right in the plane below the dorsal venous complex and above the anterior urethral wall. This manoeuvre allows for plexus ligation without involvement of the puboprostatic .