This is my first technique that I will be adding to a new section of the blog.

After watching many videos and trying different ways to approach an intravesical median lobe, I found a new way to take care of it.

The following video was uploaded to google video and shows the dissection of a median lobe.

In simple terms: The bladder holds the urine and then the urine passes through the prostate on its way out. The prostate needs to be removed completely in prostate cancer surgery. The prostate is separated from the bladder routinely during the operation.

The median lobe is the part of the prostate that sometimes pushes into the bladder. This is the main reason why some urologists elect to place scopes into peoples bladders prior to surgery. This is one of the most difficult parts of the operation for beginners and experienced surgeons. The video shows the prostate (yellow) being separated from the bladder (green). The stitch is placed into part of the prostate to lift it off of the bladder.

Instruments used: PK dissector (bipolar), hot shears (monopolar- setting coag only 30), 2 needle drivers
Suture: 2'0 vicryl on an SH needle. (I have used 0'vicryl on a CT-1 for larger median lobes)

Color scheme- Yellow- Prostate; Green bladder and bladder opening; Orange arrrow- foley

Continue reading "Delivery of the Median Lobe: A novel way to perform one of the most difficult parts of the dvP" »

Posted by Domenico Savatta, M.D. | Permalink | Comments (4) | TrackBacks (0) | | |

Dr. Menon gave a presentation at the Pacific Rim Robotics Conference on nerve preservation and the anatomical concept that he has named the veil of Aphrodite. After first reviewing the history of impotence after radical prostatectomy he described the latest modification of his techniques, which he claims further improves the preservation of potency. Originally, of course, radicals were associated with nearly 100% impotence until Dr. Walsh introduced the concept of "nerve sparing". While Walsh has at times claimed very high rates of preservation, many others felt that preservation in perhaps 50-60% of patients having a nerve sparing represented excellent results. In the introductory remarks to his talk Dr. Menon cited several papers that quoted rates of "normal" erections of only 4-33% after nerve sparing. There is clearly room for improvement.

Continue reading "ED and the Veil of Aphrodite" »

Posted by Dale Russell M.D. | Permalink | Comments (0) | TrackBacks (0) | | |