Transurethral Vaporization Of Prostate TVP
Surgeon(s)/Speaker(s): Dr. Gnanaraj Jesudian
Surgical Procedure: Urology-Prostate
Location: Seesha Karunya Hospital Coimbatore
Indexsteps
1. Diagnostic cystoscopy : Diagnostic cystoscopy, assess the size of prostate, locate the ureteric orifice. Evaluate the bladder.
2. Passage of resectoscope : Passage of resectoscope as per the size of urethra, either blind or visual
3. Resecting the median lobe : Resecting the median lobe
4. Resecting the right lateral lobe : Resecting the right lateral lobe
5. Resecting the left lateral lobe : Resecting the left lateral lobe
6. Coagulation of the prostatic fossa : Coagulation of the prostatic fossa
7. View from veru : View from veru to assess the completeness of the procedure
8. Examining both ureteric orifices : Examining both ureteric orifices
9. Evacuation of prostate chips : Evacuation of prostate chips
10. Final look and coagulation SOS : Final look and coagulation SOS
11. Catheterization : Catheterization
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. Harmonic Scalpel
2. Specimen extraction Device
3. Harmonic Ultracision
4. Laparoscopic clip appliers
5. Suction source and tubing
6. 5mm Needle Holder
7. 5mm Maryland forceps
8. Atraumatic grasper forceps
9. light source
10. PDS II- 3-0
11. Cystoscopy Sheath
12. Hysteroscope
13. Cystoscope