Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 8 • CUTTING EDGE - UROLOGY Step 3: Deploying Stay Sutures (Table 2) All the fluid is suctioned out and 2–4 stay sutures are deployed to keep the edges of the cystotomy widely retracted. These stay sutures are 2-0 Polyglactin sutures, 6-in. long, on a CT-1 needle with a medium Hem-o-lok clip tied into the end of the suture. The stay suture is passed outside-in through the bladder wall at the edge of the cystotomy, anchored laterally to the abdominal wall, then pulled taut and secured with an additional Hem-o-lok clip (Fig. 7a, b). Typically, a large prostatic adenoma that bulges into the bladder is immediately apparent. A 2-0 Polyglactin suture on a CT-1 needle stay suture is placed in the median lobe to provide trac- tion and countertraction during the procedure using the ProGrasp forceps in the fourth robotic arm (Fig. 8). Bilateral ureteral orifices are then carefully identified and care is taken to keep them safe throughout the procedure. If simultaneous bladder diverticulectomy is to be performed, or if the intravesical adenoma is extremely large and very close to the ureteral orifices, ureteral double J stents can be placed using a 2 mm mini-port deployed in the suprapubic area. A 0.035-in. guide wire is inserted through the miniport, fl oppy end first, and the n a 4.8–6 French ureteral stent is advanced over the wire (Fig. 9a–d). Table 2: Instrumentation required for deploying stay sutures. Surgeon instrumentation Assistant instrumentation Left arm Right arm Fourth arm • Hem-o-lok applier • Needle driver • Needle driver • ProGrasp™ forceps • Laparoscopic scissors • Endoscope lens : 0° Fig. 6: ( a, b ) Midline vertical cystostomy. A midline vertical cystostomy is created to gain access to the anterior portion of the bladder. Cutting EDGE_Urology(SUN)_final.indd 8 27-Mar-18 10:00:27 AM