Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co ROBOTIC SIMPLE PROSTATECTOMY • 5  Trocars zz 12 mm trocars × 2 (1 for the Xi) zz 8 mm trocars × 3 (4 for Xi) Assistant Instruments zz Suction irrigator device (Bariatric length) zz Laparoscopic spoon forceps zz Hem-o-lok applier (Teleflex Medical, Research Triangle Park, NC) zz Medium (purple) Hem-o-lok clips (Teleflex Medical, Research Triangle Park, NC) zz Laparoscopic needle driver zz Laparoscopic scissor zz 10 mm specimen entrapment bag Step-by-Step Technique (Videos 21.1, 21.2, 21.3, 21.4, 21.5, 21.6, 21.7, 21.8, and 21.9) Step 1: Pneumoperitoneum and Trocar Placement The first incision is made approximately 1–2 fingerbreadths above the umbilicus. Through this incision we establish pneumoperitoneum to 15 mmHg with a Veress needle. A 12-mm port (8 mm for the Xi) is inserted through this incision into the peritoneal cavity. The peritoneal cavity is then inspected using the 0° scope to ensure absence of any intra-abdominal injury from the Veress needle or the trocar. Four additional trocars are then inserted under direct vision. The 8-mm da Vinci® working trocars are all placed at the horizontal level of the umbilicus with a separation of 8–10 cm between trocars. We prefer to keep the fourth robotic arm on the right side of the patient. A 12-mm assistant trocar is placed in the left upper quadrant in the midclavicular line taking care to avoid being too close to the camera trocar or the left robotic arm. Thus, a 4-arm, 5-trocar trans- peritoneal approach is employed (Fig. 3). At this point, the patient is placed in Trendelenburg position, and the da Vinci® is docked (Fig. 4) betw een the legs for the Si o r from the right side of the patient for the Xi. The instruments are inserted i nto the peritoneal cavity under direct vision. We initially start with a ProGrasp™ in the left and fourt h arm and a monopolar scissor in the right arm. Step 2: Cystotomy (Table 1) The sigmoid colon is initially mobilized out of the pelvic cavity for better exposure of the target anatomy (Fig. 5a–d). The bladder is filled with approximately 200 mL of saline through the ure- thral catheter and a vertical midline cystotomy is created with monopolar scissors gaining access to the bladder lumen (Fig. 6a, b). Cutting EDGE_Urology(SUN)_final.indd 5 27-Mar-18 10:00:26 AM