Radical prostatectomy

Extraperitoneal radical prostatectomy with pelvic lymphadenectomy for cancer of the prostate gland

Extraperitoneal radical prostatectomy with pelvic lymphadenectomy for cancer of the prostate gland
Professor Gallyamov E.A. is performing an operation (2013).

In this video the technique of extraperitoneal radical prostatectomy with pelvic lymphadenectomy for cancer of the prostate gland is presented. The midline incision (the length is 3 cm) is done beneath the umbilicus, the anterior and posterior leaves of fascia of abdomival rectus muscle. A spacemaker is introduced into the preabdominal space, and the preabdominal space has been formed. A spacemaker is removed, and optic troacar is placed there. Under the visual guidance 4 working ports are established: three 5mm troacars, one 11 mm troacar. Symphysis, prostate, urinary bladder are visualized. Pelvic lymphadenectomy has been performed. Puboprostatic ligaments are transected, using Inseal Ethicon apparatus. The dorsal venous complex is exposed and stitched by “Vicryl” 1-0 thread. Detrusor fold is transected, intrapelvic fascia is opened, prostate pedicles are exposed, urethra is visualized. The urethra is transected by “cold” scissors with preserving narrow neck of urinary bladder. Deferent ducts are exposed along their length and are transected. Seminal vesicles are exposed, and are separated from tissues that are adjacent to prostate. Prostate pedicles are transected, using LigaSure apparatus. Prostate is mobilized along the posterior surface with opening Denonvillier’s fascia. Prostate apex is exposed. Dorsal venous complex is transected. The distal part of urethra is exposed. Urethra is transected by scissors. The prostate is placed into the container. Ureterocystoanastomosis has been formed by means of 2 threads V-lock 3-0 15 cm, using continuous suture. Whether anastomosis is hermetic or not, is checked by introducing 150 mL of saline solution into urinary bladder.