Sample Report: Lymphadenectomy & Prostatovesiculectomy
DIAGNOSIS: Carcinoma of the prostate.
DESCRIPTION OF PROCEDURE: In the supine position, after endotracheal anesthesia, the abdomen and genitalia were prepped and draped in the usual fashion. A midline incision was made from the symphysis pubis towards the umbilicus for about 5 inches, deepened through the subcutaneous tissues down to the fascial layer, which was incised. Retropubic exposure was accomplished, exposing the iliopsoas fossa, and this was retracted with the Bookwalter retractor to expose and allow the lymphadenectomy.
The lymphadenectomy was done in limited fashion by mobilizing the fibroareolar tissue on both sides (anterior medial and inferior to the iliac vein into the obturator fossa off the obturator nerve vessels) using medium or large hemoclips as appropriate. Frozen section revealed these to be negative. The procedure was continued by mobilizing the endopelvic fascia and incising it posteriorly to anteriorly. At the anterior portion, we incised the puboprostatic ligaments. Triple ligation of the dorsal vein complex was accomplished. Dividing between the second and third cephalad sutures, we identified the urethroprostatic angle, at which point the lateral exposure was accomplished by dividing the fascia again to drop the neurovascular bundle posterolaterally.
The posterior urethra was now incised. The catheter was removed. Dissection of the prostate off the rectum was done through Denonvilliers fascia. Proximally we were able to mobilize the lateral aspects of the pedicles between hemoclips. Seminal vesicles were exposed through incision of Denonvilliers fascia again and division of pedicles between hemoclips. The pedicles to the seminal vesicles and ejaculatory ducts were divided between Ligaclips. A portion of this ejaculatory duct was removed with the seminal vesicles, and the bladder neck was mobilized against some mild traction of the Foley, sparing about a 1-cm section of prostatic urethra. This was everted with 3-0 chromic sutures on the seromuscular layer and anastomosed to the urethra using the Greenfield suture guide. Irrigation revealed no leaks or bleeding after thorough irrigation of the pelvis. All counts were correct.
Insertion of the J-P drain was accomplished through a separate stab incision on the right side and secured using 3-0 nylon. Closure was done with a running Dexon, with subcutaneous tissues anastomosed with 3-0 Dexon and a subcuticular 3-0 Dexon suture. Steri-Strips and OpSite dressing was applied. The patient tolerated the procedure well with no complications encountered and was sent to the recovery room in stable and satisfactory condition.
IMPRESSION: Carcinoma of the prostate.