By Robert P. Myers (auth.), Hubert John, Peter Wiklund, Jorn H. Witt (eds.)
In many facilities of excellence in Urology, robot prostatectomy has turn into the 1st selection for the surgical procedure of localized prostate melanoma because of advantages equivalent to lowered ache and minimization of impotence and incontinence. This atlas, particularly designed to be used by means of surgeons, offers a fantastically illustrated, step by step advisor to all elements of the method. a number of the concepts that may be hired to accomplish first-class oncological and useful effects are conscientiously depicted in applicable aspect; for instance, nerve-sparing innovations, bladder neck reconstruction, and techniques geared toward the early recovery of continence are basically defined. exact events, similar to earlier prostate surgical procedure, a wide prostate, and salvage prostatectomy, also are totally lined. the knowledge contained during this atlas may be of serious price in permitting surgeons to enhance their effects and to take complete benefit of the advantages of robot prostatectomy in comparison with open prostatectomy.
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Extra info for Atlas of Robotic Prostatectomy
2 Before the Operation As before every operation, a premedication talk is held with the aim of exchanging information. The anaesthetist gets an impression of the current state of health of the patient during this talk, and on the basis of the medical history and the physical examination. At the same time, he informs the patient about the planned anaesthetic procedure in the form of balanced general anaesthesia. An ECG and a laboratory check are performed as standard for further diagnosis. Since our experience shows that a need for intraoperative blood transfusion is not to be expected, there is no need for corresponding preparatory measures.
1 Exposition and Incision Fig. 16 The trigone between both endopelvic fascias and the dorsal venous complex is de-fatted for further dissection 4 Surgical Steps Fig. 16 (continued) 41 42 Fig. 17 Incision of the endopelvic fascia and exposure of the dorsal vascular complex H. John et al. 2 Ligature and Stapler Fig. 18 Ligation of the dorsal vascular complex 43 44 Fig. 19 Stapling of the dorsal vascular complex H. John et al. 1 Pubovesical Ligaments: Incision Fig. 20 Incision of the right pubovesical ligament 45 46 Fig.
In their paper, Falabella et al. demonstrated an increase in the mean arterial pressure and the systemic vascular resistance, induced by the head-down position and the capnoperitoneum, along with a simultaneous reduction in the diameter of the aorta (Falabella et al. 2007). , the haemodynamic effects of a capnoperitoneum are determined by the level of the intraabdominal pressure, the degree of existing cardiocirculatory and pulmonary diseases, the patient’s volume status, the effects of the capnoperitoneum on the acid–base balance and, ultimately, also by the positioning measures required for the operation.