ssebikari
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Operative Procedure: Patient was prepped and drapped with betadine solution in the dorsal lithotomy position. Pneumoperitoneum was established in the standard fashion and the standard robotic cystectomy ports were placed. Patient was placed in trendelenburg. The sigmoid attachments were taken down sharply. The right and left ureters were identified and they were encircled with vesseloops. Next a bilateral pelvic lymph node dissection was performed, proximally the common iliac artery, distally the ingunal ligament, laterally the pelvic sidewall, medially the bladder. All lymphatic tissue was taken sparing the neurovascular elements within the space. Next the posterior perineum was opened and the pouch of douglas and the prostate and the seminal vescicles were dissected off the rectum. The lateral pedicles were taken with the Endo GIA stapler down to the level of the prostate. Next, the anterior portion of the bladder was taken down by transecting across the urachus. The fat over the top of the prostate was taken away. Bunching sutures were placed in the prostate from left to the right side in the mid prostate. The prostatic capsule was then opened and the prostate and bladder were transected making sure not to have any urinary spillage. A core of Adenoma was taken out from the prostate with a combination of cautery and sharp dissection. Hemostasis was obtained with electrocoagulation and occasional suture ligatures. At this point in time, the robort was unlocked.
