DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Prostate adenocarcinoma.
POSTOPERATIVE DIAGNOSIS:
Prostate adenocarcinoma.
OPERATION PERFORMED:
Robotic-assisted laparoscopic radical prostatectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old male patient with history of prostate adenocarcinoma. The patient had preoperative flexible cystoscopy, which demonstrated a large intravesical median lobe and was recommended for robotic-assisted laparoscopic radical prostatectomy.
DESCRIPTION OF OPERATION AND FINDINGS: After informed consent, IV antibiotics were given in the dorsal lithotomy position with usual scrub and draping under general anesthesia. A Veress needle was used to enter the peritoneal cavity and pneumoperitoneum was achieved. Inverted V-pattern trocars were placed in the abdomen. There was a 12 mm trocar for the camera just above the umbilicus. On the left and right side, 8 mm trocars from the da Vinci equipment were inserted. One also was placed in the anterior axillary line in the right lower quadrant, also 8 mm from the da Vinci equipment. A 5 mm trocar was placed in the anterior axillary line in the left lower quadrant and a 12 mm trocar just proximal to the camera site.
Then, the da Vinci robot was docked and the procedure was started. The rectus space was entered and the bladder was dissected free from the surrounding tissue. The bladder was mobilized until the pubic bone was exposed and bilateral endopelvic fascia was exposed. Then, the endopelvic fascia was opened bilaterally. The levator ani muscle was peeled off from the lateral aspect of the prostate until urethra was identified. At this time, 0 Vicryl was used in a figure-of-eight to ligate the dorsal venous complex and a stitch was placed at the base of the bladder for traction and for backbleeding. At this time, traction was placed in that suture and the dissection was started from the bladder neck and the base of the prostate. After the anterior dissection was completed, it was evident that again there was a big prostatic lobe protruding into the bladder. The mucosa was scored on this lobe and peeled off from the lobe. Then, using blunt and sharp dissection, the vesicles were identified. Seminal vesicles were dissected from the surrounding tissue using electrocautery. The patient had a lot of inflammation between the posterior prostatic wall and the anterior rectal wall. When the dissection was completed, there was one area that the rectal wall appeared to be thin, where there was a small bulge of mucosa. For that reason, 2 figure-of-eight Vicryls were placed in that area imbricating the rectal wall muscle.
Then, the lateral pedicles of the prostate were taken down using bipolar electrocautery and a hook electrocautery. The urethra was transected using sharp scissors. The prostate was placed in a catch bag. Then, the bladder neck was left with a large opening and that was reconstructed using interrupted 3-0 Vicryl in a racquet fashion. Indigo carmine was used to identify the ureteral orifices that were shown to be far from the bladder neck. After this was completed, then an end-to-end anastomosis of the bladder neck and membranous urethra was accomplished by using a running suture of a 3-0 Monocryl, that was done over a 20 French 100% silicone catheter. The balloon was inflated with 30 mL of water and that was irrigated without evidence of extravasation. Then, a round #5 drain was placed in the pelvic space through one of the trocar sites. Using grasping forceps through the camera site, the EndoCatch was attached to the skin and then the midline camera site fascia was opened and the prostate was removed. The fascia was closed with 0 Vicryl and the skin was closed with 4-0 Vicryl. Estimated blood loss was 600 mL. The patient tolerated the procedure well and was sent to the recovery room in good condition.
