Miko24
Guru
I am not sure if this would require an unlisted code
The robot was docked. Some minor sigmoid colon adhesions were taken down. The fourth arm was then used to retract the colon out of the way. The bladder was already mildly distended. A Toomey syringe was used to directly inject into the meatus to fill the bladder further. A midline cystotomy was performed to allow for entry of the robotic arms into the bladder. The trigone had evidence of radiation change. The ureteral orifice ease were readily visible they were marked with electrocautery for identification throughout the case. The known bladder neck contracture was visualized as well as the calcification within the fossa. The fourth arm was used to retract the posterior portion of the bladder posteriorly. I then used electrocautery to make incisions in the bladder neck at the 5 and 7 o'clock position allowing posterior release and improve visualization I then sequentially used the robotic arms and some small amount of cautery removed to the prostatic fossa stones withdrawn and the bladder and placing them on a laparoscopic sponge this then proceeded until the prostatic fossa was clear. Intermittently I irrigated out small pieces once clear. The laparoscopic sponge containing all sponge was rolled up and placed in a specimen bag. Once clear I then advanced a 14 French Foley catheter through the urethra. Of note I deactivated the AUS at the beginning of the case prior to prepping. The catheter passed without any resistance and the tip was readily visible. I previously already developed a V shaped wedge of bladder mucosa at the distal portion of the trigone I mobilized the posterior surface of this to increase his mobility and then using 2 separate 3 oh V-Loc's I passed those through the trigone mucosa and then used them to pass the needles as far distally into the prostate fossa as I could. I could not get the needles all the way to the ventral edge of the urethra due to reduced mobility from the pelvis bones but was able to advance the bladder mucosa approximately 1/2-2/3 of the way through the prostatic fossa. The V-Loc's were then cinched down advancing the mucosa forward. I then passed a 14 French 1 more time it passed easily into the bladder without any obstruction or resistance. 10 mL balloon was then inflated. Electrocautery was used to fulgurate some areas of bleeding mucosa and detrusor fibers.
The robot was docked. Some minor sigmoid colon adhesions were taken down. The fourth arm was then used to retract the colon out of the way. The bladder was already mildly distended. A Toomey syringe was used to directly inject into the meatus to fill the bladder further. A midline cystotomy was performed to allow for entry of the robotic arms into the bladder. The trigone had evidence of radiation change. The ureteral orifice ease were readily visible they were marked with electrocautery for identification throughout the case. The known bladder neck contracture was visualized as well as the calcification within the fossa. The fourth arm was used to retract the posterior portion of the bladder posteriorly. I then used electrocautery to make incisions in the bladder neck at the 5 and 7 o'clock position allowing posterior release and improve visualization I then sequentially used the robotic arms and some small amount of cautery removed to the prostatic fossa stones withdrawn and the bladder and placing them on a laparoscopic sponge this then proceeded until the prostatic fossa was clear. Intermittently I irrigated out small pieces once clear. The laparoscopic sponge containing all sponge was rolled up and placed in a specimen bag. Once clear I then advanced a 14 French Foley catheter through the urethra. Of note I deactivated the AUS at the beginning of the case prior to prepping. The catheter passed without any resistance and the tip was readily visible. I previously already developed a V shaped wedge of bladder mucosa at the distal portion of the trigone I mobilized the posterior surface of this to increase his mobility and then using 2 separate 3 oh V-Loc's I passed those through the trigone mucosa and then used them to pass the needles as far distally into the prostate fossa as I could. I could not get the needles all the way to the ventral edge of the urethra due to reduced mobility from the pelvis bones but was able to advance the bladder mucosa approximately 1/2-2/3 of the way through the prostatic fossa. The V-Loc's were then cinched down advancing the mucosa forward. I then passed a 14 French 1 more time it passed easily into the bladder without any obstruction or resistance. 10 mL balloon was then inflated. Electrocautery was used to fulgurate some areas of bleeding mucosa and detrusor fibers.