Lap Radical Prostatectomy with Pelvic Lymphadenectomy
Education event Sponsored by: Medtronic
Conference Name: Lap Urology Series
Conducted by: Dr. R. K. Gopalakrishna
Surgeon(s)/Speaker(s): Dr. R. K. Gopalakrishna
Surgical Procedure: Urology-Prostate
Location: Fortis Hospital, Kolkata
Indexsteps
1. Preoperative check list : *Adequate hydration *Antibiotics *Consents *Checking all the machines *Checking instruments *Checking CMG report
2. Anesthesia : * Spinal anesthesia* Good hydration
3. Cystoscopy to asses the prostate : Cystoscopy to asses the prostate, the position of the veru montanum, to rule out stones in the bladder
4. Passage of the resectoscope. : Passage of the resectoscope.
5. Markings near the veru : *Creating a passage starting at 6 o'clock position *Vaporizing till the capsule [white tissue] *Going all around vaporizing
6. Resecting few pieces for biopsy : *Resecting few pieces for biopsy *Hemostasis *Placement of 3 way catheter *Irrigation
port positions
1. Patient Position for TVP : * Lithotomic Position * Electrocautery machine: 400 watts pure cut for vaporization & 200 watts for resection
pre_post_measures
1. Preoperative investigations : lab parameters: routine: : hb, cbc, sr creat, urine r/m, bld grp, pt, ptt, platelet, hiv, hbsag :new: blood sugar random (fasting and postprandial, if diabetic) :new:if partient has ckd: then urea, creatinine, na, k :new: coagulation profile :new: usg abdomen and pelvis :new: psa if necessary :new: phycician opinion and other inv as directed by physician like: chest x-ray, ecg, echocardiogram :new: abdominal ultrasound examination
2. Preoperative measures : hospitalized one day prior in night :new:attachment of the diathermy plate :new:padding of the pressure points :new:lithotomy position :new:dose of prophylactic antibiotic at the time of induction of anaesthesia :new:anti-embolic stockings / placement of an intermittent compression device on the legs if necessary
3. Postoperative measures : monitoring of temperature, pulse and blood pressure :new:allow the patient liquids and diet after 3-4 hours :new:intravenous fluids for the first 6 - 12 hours :new:catheter removal on day 2,3 or 4 depending on bleeding and whether the patient has passed motion or not
4. Warning signs in the postoperative period : patient feels unwell anytime :new:hematuria :new:tachycardia :new:hypotension :new:fever
Surgical Instruments
1. Vloc Sutures
2. ValleyLab FT10 Energy Platform
3. Ligasure Maryland jaw
4. Harmonic Scalpel
5. Specimen extraction Device
6. Harmonic Ultracision
7. Laparoscopic clip appliers
8. Suction source and tubing
9. 5mm Needle Holder
10. 5mm Maryland forceps
11. Atraumatic grasper forceps
12. light source
13. PDS II- 3-0
14. Cystoscopy Sheath
15. Hysteroscope
16. Cystoscope
