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An open simple prostatectomy was performed. This procedure was done to treat benign prostatic hypertrophy. Here is the operative report any ideas?
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient's
identity was confirmed in the preoperative holding area. He was brought
back to the operating room, sedated, and intubated by anesthesia.
Antibiotics consisting of vancomycin and Zosyn had been administered
preoperatively. Perioperatively, he received Ancef. His catheter was
removed after irrigated the bladder with GU irrigant, and we then prepped
and draped him for flexible cystourethroscopy. We noted an approximately
7-cm prostatic urethra, a very small median lobe, and the ureteral
orifices were able to be visualized. At this point, he was positioned
supine for the simple prostatectomy. He was clipped, prepped and draped
in the usual sterile fashion.
An incision was made in the midline between the umbilicus and pubic
symphysis, and the dissection was taken all the way down to the fascia.
The fascia was opened in the midline. The space of Retzius was developed,
as well as the gutters on either side down to the external iliac vein. We
were able to identify the very large prostate. We had inserted a
24-French 3-way Foley catheter, and approximately 40 mL of water had been
instilled into this. This was palpable within the bladder. We brought in
a Balfour retractor. The middle blade was used to retract the Foley
catheter balloon cephalad. We then divided the superficial dorsal vein
between ties. At this point, we marked out our incision in the anterior
aspect of the mid prostate with a marking pen. On either side of this
incision, we placed figure-of-eight stitches using 2-0 Vicryl. We then
incised through the capsule. We developed the space between the capsule
and the adenoma, again, between our 2 stitches. There was some
back-bleeding. We placed a 2-0 Vicryl here over the back-bleeding and
then in the peripheral aspect of the dorsal venous complex, we used a 2-0
Monocryl on a UR-6 needle in a horizontal mattress fashion, running from
the left side of the prostate to the right for hemostasis. We had
excellent hemostasis at this point. We were able to get all the way
around the adenoma between the capsule and the adenoma. We fractured it
in the middle anteriorly. We fractured it at the apex, taking care not to
distract or damage the sphincter. We then got it all the way around to
the bladder neck and took it off in the capsule here. It was removed in 2
pieces that measured approximately 180 grams.
At this point, the capsule was inspected. There were a couple of bleeding
areas, and these were oversewn. We then placed 2 mucosal advancement
stitches using Vicryl, and then we brought our catheter down into the
field for hemostasis. We closed the capsule using a 2-0 Monocryl on a
UR-6 needle. Again, there was good hemostasis. We placed a drain. We
closed the fascia with a #1 nonlooped PDS from above and below, and we
tied it in the middle. We closed Scarpa's with interrupted Vicryls, and
then we closed the skin with clips.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient's
identity was confirmed in the preoperative holding area. He was brought
back to the operating room, sedated, and intubated by anesthesia.
Antibiotics consisting of vancomycin and Zosyn had been administered
preoperatively. Perioperatively, he received Ancef. His catheter was
removed after irrigated the bladder with GU irrigant, and we then prepped
and draped him for flexible cystourethroscopy. We noted an approximately
7-cm prostatic urethra, a very small median lobe, and the ureteral
orifices were able to be visualized. At this point, he was positioned
supine for the simple prostatectomy. He was clipped, prepped and draped
in the usual sterile fashion.
An incision was made in the midline between the umbilicus and pubic
symphysis, and the dissection was taken all the way down to the fascia.
The fascia was opened in the midline. The space of Retzius was developed,
as well as the gutters on either side down to the external iliac vein. We
were able to identify the very large prostate. We had inserted a
24-French 3-way Foley catheter, and approximately 40 mL of water had been
instilled into this. This was palpable within the bladder. We brought in
a Balfour retractor. The middle blade was used to retract the Foley
catheter balloon cephalad. We then divided the superficial dorsal vein
between ties. At this point, we marked out our incision in the anterior
aspect of the mid prostate with a marking pen. On either side of this
incision, we placed figure-of-eight stitches using 2-0 Vicryl. We then
incised through the capsule. We developed the space between the capsule
and the adenoma, again, between our 2 stitches. There was some
back-bleeding. We placed a 2-0 Vicryl here over the back-bleeding and
then in the peripheral aspect of the dorsal venous complex, we used a 2-0
Monocryl on a UR-6 needle in a horizontal mattress fashion, running from
the left side of the prostate to the right for hemostasis. We had
excellent hemostasis at this point. We were able to get all the way
around the adenoma between the capsule and the adenoma. We fractured it
in the middle anteriorly. We fractured it at the apex, taking care not to
distract or damage the sphincter. We then got it all the way around to
the bladder neck and took it off in the capsule here. It was removed in 2
pieces that measured approximately 180 grams.
At this point, the capsule was inspected. There were a couple of bleeding
areas, and these were oversewn. We then placed 2 mucosal advancement
stitches using Vicryl, and then we brought our catheter down into the
field for hemostasis. We closed the capsule using a 2-0 Monocryl on a
UR-6 needle. Again, there was good hemostasis. We placed a drain. We
closed the fascia with a #1 nonlooped PDS from above and below, and we
tied it in the middle. We closed Scarpa's with interrupted Vicryls, and
then we closed the skin with clips.