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Thread: Urology ASC?

  1. #1
    Join Date
    Apr 2007

    Question Urology ASC?

    AAPC: Back to School
    An open simple prostatectomy was performed. This procedure was done to treat benign prostatic hypertrophy. Here is the operative report any ideas?

    DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient's
    identity was confirmed in the preoperative holding area. He was brought
    back to the operating room, sedated, and intubated by anesthesia.
    Antibiotics consisting of vancomycin and Zosyn had been administered
    preoperatively. Perioperatively, he received Ancef. His catheter was
    removed after irrigated the bladder with GU irrigant, and we then prepped
    and draped him for flexible cystourethroscopy. We noted an approximately
    7-cm prostatic urethra, a very small median lobe, and the ureteral
    orifices were able to be visualized. At this point, he was positioned
    supine for the simple prostatectomy. He was clipped, prepped and draped
    in the usual sterile fashion.

    An incision was made in the midline between the umbilicus and pubic
    symphysis, and the dissection was taken all the way down to the fascia.
    The fascia was opened in the midline. The space of Retzius was developed,
    as well as the gutters on either side down to the external iliac vein. We
    were able to identify the very large prostate. We had inserted a
    24-French 3-way Foley catheter, and approximately 40 mL of water had been
    instilled into this. This was palpable within the bladder. We brought in
    a Balfour retractor. The middle blade was used to retract the Foley
    catheter balloon cephalad. We then divided the superficial dorsal vein
    between ties. At this point, we marked out our incision in the anterior
    aspect of the mid prostate with a marking pen. On either side of this
    incision, we placed figure-of-eight stitches using 2-0 Vicryl. We then
    incised through the capsule. We developed the space between the capsule
    and the adenoma, again, between our 2 stitches. There was some
    back-bleeding. We placed a 2-0 Vicryl here over the back-bleeding and
    then in the peripheral aspect of the dorsal venous complex, we used a 2-0
    Monocryl on a UR-6 needle in a horizontal mattress fashion, running from
    the left side of the prostate to the right for hemostasis. We had
    excellent hemostasis at this point. We were able to get all the way
    around the adenoma between the capsule and the adenoma. We fractured it
    in the middle anteriorly. We fractured it at the apex, taking care not to
    distract or damage the sphincter. We then got it all the way around to
    the bladder neck and took it off in the capsule here. It was removed in 2
    pieces that measured approximately 180 grams.

    At this point, the capsule was inspected. There were a couple of bleeding
    areas, and these were oversewn. We then placed 2 mucosal advancement
    stitches using Vicryl, and then we brought our catheter down into the
    field for hemostasis. We closed the capsule using a 2-0 Monocryl on a
    UR-6 needle. Again, there was good hemostasis. We placed a drain. We
    closed the fascia with a #1 nonlooped PDS from above and below, and we
    tied it in the middle. We closed Scarpa's with interrupted Vicryls, and
    then we closed the skin with clips.

  2. #2
    Join Date
    Apr 2007
    Tacoma, WA



  3. #3
    Join Date
    Apr 2007

    Default urology asc

    Thanks ssmith this is the code I came up with too. Sorry I am responding so late.


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