UroToday - WCE 2007 - Single Knot Anastomosis (SKA) For Laparoscopic Radical Prostatectomy: An International Multicenter Outcome Survey of 5235 Cases

They have shown that the time to complete the anastomosis for the expert, second generation, and trainee surgeons were 16, 23, and 30 minutes respectively. Additional stitches were necessary only in 1.1%. The anastomosis was water tight in 94.2%. Early leakage requiring prolonged catheter drainage occurred 6.8% of laparoscopic cases and 0% in the robotic assisted cases. Mean catheter time was 7.1 days. The bladder neck contracture rate was 0.8% at 12 months and the rate of acute urinary retention was 0.5%.

Dr. van Velthoven deserves credit dor being the first to devise a simpler, likely better way to make the bladder to urethra connection. Most surgeons, including myself, use this technique.
This large series shows the average time for a connection is 16 minutes and the average catheter is kept in for 1 week.
Some surgeons catheter times are much faster. I have watched Dr Patel and Dr Tewari perform the connection in well under 10 minutes, probably about 5.

My main work currently is trying to reduce the catheter time to as a few days as possible. I think with robotics we can cut down the catheter time to 3 days at least.

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UroToday - AUA 2007 ABST[550] Curtain Dissection of the Lateral Prostatic Fascia and Potency Following Laparoscopic Radical Prostatectomy - A Veil of Mystery

Conclusions: CD produced a significantly higher potency rate at 1 month following LRP but similar rates thereafter, which are in step with previously reported values (Rozet, 2004). Notably, CD failed to reproduce the results of Menon et al. despite the advantage of avoiding cautery at all stages during NVB preservation in our patients. We believe that the merit of this technique is in allowing a clearer appreciation of the contour of the prostate base at the commencement of antegrade NVB dissection, rather than preserving important nerve fibres. This may explain the lower basal positive margin rate in the CD group of 0% vs 5.8% in control cases (p=0.007).

Continue reading "Veil of Aphrodite at the time of robotic prostatectomy" »

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