JACKMAN RALP

Preop:

– heparin sc, ancef

– lithotomy

– tuck arms

– tape across chest w/ foam

– test total trendelenburg stability

-prepxiphoid to scrotum w/ penis

Site marks: total 6 ports

– umbilicus and top of pubic symphysis (draw line)

– once insufflated via RUQ veress:

– 8cm to L and R of umbilicus

– RLQ above ASIS

– LLQ parallel to L port

– 5mm port at veress needle site

Procedure:

1. Insufflate Veress needle to 20mmHg

2. Visiport zero degree scope to enter above umbilicus

3. Make port incisions

4. Place robotic trocars two on L, one on R

5. 5mm port RUQ veress site

6. 12mm RLQ port

7. dock robot

8. lysis of adhesions

9. dissect bladder to develop space of Retzius: laterally first thencentrally using urachus

10. defat prostate

11. endopelvic fascia: expose and enter with scissors

12. dissect prostate laterally

13. ligate dorsal vein figure of 8 with O-Vicryl

14. switch to 30 degree scope

15. transect bladder neck laterally first, then medially until catheter reached

16. retract catheter upward with microfranz

17. transect posterior bladder neck until vas and seminal vesicles andvasa deferentia are identified

18. dissect out seminal vesicles and vasa deferentia with scissors

19. transect vasa deferentia and dissect out seminal vesicles “unwrap”

20. develop place between prostate and rectum (Denonvilliers’ fasciawill need to be incised)

21. spare neurovascular bundle by incising the lateral prostaticfascia and sweeping the bundle posterolaterally. Dissect to apex ofprostate

22. develop plane and Hem-o-lock clip the prostatic pedicles or cutwith bipolar cautery

23. incise apex of prostate starting with dorsal vein with cautery

24. use cold scissors to cut uretyhra

25. free prostate from residual rectal attachments

26. place in endocatch bag

27. assess hemostasis: may need Flow-seal applicator

28. urethral anastomosis with 3-0 monocryl double-armed suture

29. place new 18F catheter

30. inflate with 13cc

31. infuse 120cc NS and check for water tight seal of anastomsis

32. undock robot

33. bring prostate out midline umbilical port

34. close midline with 0 Maxon looped

35. remove remaining ports under direct vision, and verify closure of abd wound

36. Steries

Postop:

PSA 1,3,6,9,12 months

f/u void trial in 1 week (cipro in am of appt)

“dribbling will improve”

Cialais 1/2 pill 2 x q wk

– longer acting than viagra

– prevent atrophy

– inc blood flow to penis

f/u 3 months

Kegal exercises/stop flow

– strengthen sphincter