Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 14 • CUTTING EDGE - UROLOGY are removed by the assistant using a laparoscopic spoon forceps. The midline cystotomy is now closed in two layers; the first is an inner full thickness layer using 2-0 V-loc™ sutures on a GS-21 needle (Fig. 14) and the second layer is also a full thickness layer using the same sutures (Fig. 15). After the first layer is complete, the bladder is filled with 200 mL of saline to ensure the closure is watertight and also to avoid hitting the urethral catheter balloon with the second layer closure. Table 5 : Instru mentation re quired for step 5: bladder closure. Surgeon instrumenta tion Assistant instrumentation Left arm Right arm Fourth arm • Laparoscopic suction irrigator • Needle driver • Needle driver • ProGrasp™ forceps • Laparoscopic spoon—to remove Hem-o-lok clips from stay sutures • Laparoscopic needle driver • Endoscope lens : 0° Fig. 13: Hemostasis. ( a–d ) Hemostatic sutures are placed at bleeding sites within the fossa to provide hemostasis. 4-0 Vicryl sutures and spot coagulation are performed to complete this step. Cutting EDGE_Urology(SUN)_final.indd 14 27-Mar-18 10:00:28 AM