Hai mạch máu tiếp hợp với nhau bây giờ là tiếp tục theo chiều ngang trên cả hai bên. Ở phía bên trái (09:00), các mũi khâu được ném trái tay, trái tay và ở phía bên phải (03:00) thuận tay, thuận tay, như được hiển thị. Các mũi khâu này là tương đối dễ dàng để thực hiện và nên được thực hiện trong một bước | 112 Chapter 7 . Stolzenburg R. Rabenalt M. Do E. Liatsikos 7 The anastomosis is now continued laterally on both sides. On the left side 9 o clock the stitches are thrown backhand-backhand and on the right side 3 o clock forehand-forehand as shown. These stitches are relatively easy to perform and should be performed in one step stitch the bladder and urethra in one move . If during the bladder neck dissection a bladder neck-preserving technique is not feasible a bladder neck reconstruction at a 12 o clock position is deemed necessary at this point. Use a running suture with the same needle and suture material. Alternatively single stitches can be placed. Make sure that the stitches are full thickness on the bladder wall. Technique of EERPE - Step by Step Chapter 7 113 The final two anastomotic sutures are placed at 11 and 1 o clock positions left side backhand-backhand right side forehand-forehand . For the 11 o clock stitch the needle holder is introduced through the right medial 5-mm trocar on the assistant s side . This stitch is thrown backhand at the bladder neck and backhand at the urethra and can be performed in one or two moves. For knot tying the needle holder is moved back to its initial position. When suturing the urethra these stitches 11 o clock and 1 o clock should not include the whole tissue of the urethra. They should embrace the Santorini plexus connective tissue and puboprostatic ligament not through the mucosa and the musculature of the urethra thus avoiding any damage to the external urethral sphincter and its blood supply and finally fixing the new bladder neck to its anatomical position not shown . After conclusion of the stitching process the catheter must be moved to make sure that there is no entrapment within the suture lines very rare . The water-tightness of the anastomosis is finally checked by filling the bladder with 200 ml sterile water. Lateral and ventral leaks can be managed by additional suturing. In the case of a major .
