mnowitzke
New
Doc coded the following as a 55866 and a 51999......any yays or nays?
Cautery was used to dissected the bladder away from the prostate. After the anterior bladder neck was incised and the bladder entered the the posterior bladder neck was exposed and the ureteral orifces identified. The posterior bladder neck was then incised and dissected away from the prostate. The bladder neck was noted to be normal and did not require reconstruction. The vas and the seminal vesicles were now exposed and dissected to their insertions into the prostate and were not spared. The posterior layer of the Denonvillier's fascia was incised to enter ino the plane between prostate and perirectal fat.
Each lateral pedicle was controlled with clips for hemostasis. Nerve preservation was performed as listed above. The puboprostatic ligament was incised where it inserted into the apex of the prostate and a plane between urethra and dorsal venous complex divided to expose the anterior urethral surface. The DV was sutured. The anterior wall of the urethra was transected with the scissors a few millimeters distal to the apex of the prostate. The freed specimen was then placed in an endo-catch specimen retrieval bag. The prostate was removed following the completion of the anastomosis.
Two 3-0 monocryl stitches (MVAC) tied togther to form a pledget were used to complete the running continuous circumferential urethrovesical anastamosis with dual layer reconstruction. The outer layer MVAC suture was placed initially to reapproximate denonvillier's fascia posteriorly before placing the inner layer MVAC suture as the urethrovesical anastamosis proper. After the inner layer was tied, the anastamosis was checked for leaks before closing the outer layer laterally and anteriorly. A new 20 French Foley catheter was introduced and inflated to 20cc. The bladder was filled with 250 cc saline, with the balloon to test the integrity of the anastomosis. No leak was identified.
A 14 french punch suprapubic tube was inserted percutaneously and guided into the bladder with robotic assistance with 200 cc placed into the bladder. The bladder was then pulled to the anterior abdominal wall with a preplaced suture on a keith needle that was delivered alongside the SPT, then purse-stringed around the catheter and delivered back out of the body alongside the SPT.
thanks,
Michele
Cautery was used to dissected the bladder away from the prostate. After the anterior bladder neck was incised and the bladder entered the the posterior bladder neck was exposed and the ureteral orifces identified. The posterior bladder neck was then incised and dissected away from the prostate. The bladder neck was noted to be normal and did not require reconstruction. The vas and the seminal vesicles were now exposed and dissected to their insertions into the prostate and were not spared. The posterior layer of the Denonvillier's fascia was incised to enter ino the plane between prostate and perirectal fat.
Each lateral pedicle was controlled with clips for hemostasis. Nerve preservation was performed as listed above. The puboprostatic ligament was incised where it inserted into the apex of the prostate and a plane between urethra and dorsal venous complex divided to expose the anterior urethral surface. The DV was sutured. The anterior wall of the urethra was transected with the scissors a few millimeters distal to the apex of the prostate. The freed specimen was then placed in an endo-catch specimen retrieval bag. The prostate was removed following the completion of the anastomosis.
Two 3-0 monocryl stitches (MVAC) tied togther to form a pledget were used to complete the running continuous circumferential urethrovesical anastamosis with dual layer reconstruction. The outer layer MVAC suture was placed initially to reapproximate denonvillier's fascia posteriorly before placing the inner layer MVAC suture as the urethrovesical anastamosis proper. After the inner layer was tied, the anastamosis was checked for leaks before closing the outer layer laterally and anteriorly. A new 20 French Foley catheter was introduced and inflated to 20cc. The bladder was filled with 250 cc saline, with the balloon to test the integrity of the anastomosis. No leak was identified.
A 14 french punch suprapubic tube was inserted percutaneously and guided into the bladder with robotic assistance with 200 cc placed into the bladder. The bladder was then pulled to the anterior abdominal wall with a preplaced suture on a keith needle that was delivered alongside the SPT, then purse-stringed around the catheter and delivered back out of the body alongside the SPT.
thanks,
Michele